District 14 Coast Guard Ball 2010 Request Form

District 14 2010 CG Ball header image

You're almost done....please take a moment to complete the form below so we may better serve your needs.
The Ball Committee would like to thank you for your patronage, and we hope you have an enjoyable evening at the ball.

For questions concerning this form email Liko Smith or contact her at (808) 753-1001.

Please provide the following contact information:
Name:
Rank/Grade:
Unit/Organization:
Email:
Phone Number:

Please select your Entree Choice:

London Broil

Stuffed Chicken Breast

Vegetarian - Steamed mixed vegetables on linguini with side sauce

Special Diet Needs (list below): (i.e. No peanuts, lactose intolerant, etc.)
Will your spouse or guest be accompanying you? Yes No

Please provide Spouse/Guest's name for table placeholder:

Title:
First Name

Last Name

Please provide Spouse/Guest's Entree:

London Broil

Stuffed Chicken Breast

Vegetarian - Naked Eggplant Parmesan

Special Diet Needs (list below): (i.e. No peanuts, lactose intolerant, etc.)

Will you be staying at Hickam's Lodging Facility Yes No What paygrade (select one) 05 and above 04 and below

Do you need Childcare?       Yes No

If you answered yes, please provide names and ages below:

Name:         Age:         Special Needs/Allergies:

Name:         Age:         Special Needs/Allergies:

Name:         Age:        Special Needs/Allergies:
If you made a donation for a table; please provide the names in your party below:

Name:                                 Name:

Name:                                 Name:

Name:                                 Name:

Name:                                 Name:

Name:                                 Name:
Do you have a seating preference (ie desire to sit next to ....)?

Additional Comments or Notes:

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©2010 U.S. Coast Guard D14 Ball Committee - No Ka Oi

Form created by CG Ball Webmaster.Copyright © D14 CG Ball 2010 Committee. All rights reserved. Revised: 05/19/10

Form created by CG Ball Webmaster.
Copyright © D14 CG Ball 2010 Committee. All rights reserved.
Revised: 05/19/10