Democratic Party of Collin County Ann Richards Dinner Reservation Form

2011 5th Annual Ann Richards Dinner & Silent Auction
This Year's Program Theme: "Standing Up for Everyday Citizens"

The Democratic Party of Collin County
2504 K Avenue, Suite 200
Plano, Texas 75074
972-578-1483

Once you fill out this form, you will be forwarded to another form that will send you to the PayPal web site
where you may make your purchase online with a credit card or PayPal account.
If you wish to pay by check, fill out and submit this form and mail your check to the DPCC HQ address above.
If you have any trouble using this form, please email office@collindems.us or call our office at (972) 578-1483.

Please fill in all fields marked with a *

Number of Reservations Needed: *

Reserve Entire Table of 8 Seats for $500
Number of seats at $60 per seat:

Names of people that will be attending (If known at this time):
(Over 8, please email richardsdinner@collindems.us)

First Name

Last Name

Address

City

State

Zip

Home Phone

Email Address

Cell Phone

If self employed, Check box on the left and enter "self" as your employer.

Employer:

Occupation:

By donating as an individual, you confirm that the following are true and correct:
* You are at least 18 years old.
* You are a United States Citizen or a permanent resident alien.
* The funds I am donating are not being provided to me by another person
or entity for the purpose of making this contribution.

If you can not meet these conditions, and still want to donate, contact us by using the contact information at the top of the page.

Other Comments:

Click on the "Submit Form" button below to email your information to the
Democratic Party and be forwarded to the amount and donation method selection page.