Sunday, October 16th, 2005                                eveningwiththestars.com

7-10 pm

The Ivar, Hollywood, CA

Note: All guests must be 21 or older.   

                                        

No cameras permitted - photo opportunities will be provided

Cocktail Attire

 
Please print and complete this application and mail 

with your tax deductible donation of $55 per person before 9/30/05 and $65 from 9/30 - 10/16 to:

Desi Geestman Foundation

"Touching the lives of children with cancer"
3131 Foothill Blvd. Suite L
La Crescenta, CA 91214

or FAX  to (818) 249-1003


The Desi Geestman Foundation is a non-profit 501(c)3 organization # 95-4728343. 

For further information please call the foundation offices at 818-249-1105.

 

How did you hear about this event?  __________________________________________

Please consult you tax advisor for tax benefits.


        

Name:________________________________________________

Address:_____________________________________________

City:___________________________State:_______________

Zip:______________Telephone:_________________________

E-mail:______________________________________________

            Number of tickets requested:_____________

         X $55 (before 9/30/05 = TOTAL:_______________

           X $65 (9/30/05-10/16/05)= TOTAL:_______________

Checks, VISA and MasterCard accepted
Make checks payable to Desi Geestman Foundation.

______________________________  _____________________
Credit Card #         Exp. Date

Signature ___________________________________________