Cerritos College Inaugural Hall of Fame Dinner & Awards
Space is limited (Please respond by ursday, March 29, 2012)
Submitted by
Name Preferred Phone
Address Email Required*
City, State, Zip
*Email conrmation will be sent in lieu of tickets.
❑ Reserved Table of 10 ($400) $
❑ Dinner ($45 per person) $
❑ I cannot attend, but I would like to make a donation $
Dinner Attendees (Please Print)
1. 6.
2. 7.
3. 8.
4. 9.
5. 10.
Method of Payment
❑ Check payable to Cerritos College Foundation Amount $
❑ Credit Card (Master Card, Visa, American Express)
Credit Card # Exp. Date
Name on Card
Authorized Signature Amount $
To pay by phone, call (562)467-5053, ext. 7
click to sign
signature
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