TO BENEFIT THE SILENT WITNESS PROGRAM
Silent Witness hosts the 4th annual Trivia Night.
THURSDAY, APRIL 27, 2017, 6-9 p.m. at Aunt Chilada’s - 7330 North Dreamy Draw Dr, Phoenix
Teams of 4 Players - Buffet Dinner included - No Host Bar - Live Auction - Raffle
Team / Players Registration Form
CONTACT (Person completing this form):
______________________________________________
First Name / Last Name
______________________________________________
Street Address
______________________________________________
Email Address
_________________________________________________
Company Name
_________________________________________________
City / State / Zip
_________________________________________________
Phone
PLAYERS
PRICE:
Single Player
$50
Team of 4
$200
QTY:
$
TOTAL:
PLAYERS NAMES:
TOTAL:
$
E-MAILS:
Team name:_________________________________
PAYMENT OPTIONS: Register Online at : www.SilentWitnessAZ.org
____CHECK PAYMENT
____CREDIT CARD PAYMENT
Please make check payable to: Silent Witness
Mail checks to: Silent Witness Inc.
620 W Washington St
Phoenix, AZ 85003
Name on Card:_________________________________
Credit Card #:__________________________________
Expiration:__________ Security Code:____________
Billing Zip:_______________
Questions: contact Cynthia Ecker 602-363-2310
Silent Witness Inc. is a 501(C)(3) non-profit. EIN 86-0363598