Greek Orthodox Church

of Northern Virginia

presents

2004

Annual Dinner Dance

Saturday, November 6, 2004

Reception 6:00 p.m. • Dinner 7:00 p.m.

$65 per person

$30 Children (12 & under)

Location: St. Katherine’s Community Center

For more information, please contact:

Ø      George Moshos 202-409-2302

Ø      Mallamo Mavromatakis 703-830-0224

Ø      Church Office 703-671-1515

TICKET RESERVATION FORM

St. Katherine 2004 Annual Dinner Dance

$650 Sponsor (table of ten)

$65 Individual Adult Ticket

$30 Child Ticket (12 & Under)

Please reserve ____ seat(s) @ $65 each.

Please reserve ____ table(s) @ $650 each.

Please reserve ____ child seats(s) (12 and under) @ $30 each.

(For purposes of planning, please RSVP by November 3, 2004)

Please Print Clearly. Thank You.

Name__________________________________________________________________

Address_________________________________________________________________

City_____________________________________State________Zip________________

Daytime Phone_______________________Evening Phone_______________________

Enclosed is the check in the amount of $____________ or

Please bill my: VISA MC Exp. Date_____/_____

Card No.___________________________ Signature_____________________________

I cannot attend, but I wish to make a tax-deductible contribution of $__________.

Please list the name(s) of your guest(s) on the back of this form. Please make checks payable to St. Katherine Greek Orthodox Church. Contributions are tax-deductible, less the estimated fair market value of goods and services rendered. For further information, please call 703-671-1515.