Name _____________________________________________________Company______________________________________Address ________________________________________________________________________________________________City _____________________________________________________________State ______________Zip _________________Phone (____)_______________________________________Email _________________________________________________

Tables of 8 and 10 Only. Please seat these guests at my table.

__________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________

10

8

4

2

Single Reservation: $75/person $85/person after October 30, 2015

$2,000: Classic & Dry Sponsorship

$1,000: Olives & a Twist Sponsorship

$500: Top Hat & Tails Sponsorship

$250: Vermouth Sponsorship

I would like to donate a SILENT AUCTION item. Please call to arrange.

Register, Become a Sponsor, or Donate Auction Items: www.shakennotstirred.auction-bid.org. Online Bidding Starts November 14, 2015Complete this form and mail with your payment, or fax it to: Crossroads Regional Chamber of Commerce • 9101 Taft Street Merrillville, IN 46410 • Fax: 219.736.6223

[ Select One ] [ No. of Reservations ] [ $ Amount ]

Presenting Sponsor Franciscan Alliance

To sponsor, donate or for more information call 219.769.8180 or visit www.crossroadschamber.org

Entertainment Sponsor Electrical Professionals at IBEW Local 697

[ SATURDAY, NOVEMBER 21, 2015 ]

[ You’re invited ]

Radisson Star Plaza

Merrillville, Indiana

• 6:00 p.m.

Cocktails and Hors D’oeuvres

Cocktail Hour Entertainment: Jim Bulanda

• 7:00 p.m.

Awards Presentation and Dinner

• 8:30 p.m. - 11:30 p.m.

Dancing and Open Bar

Evening Entertainment: Standing Room Only Orchestra

$75/person All Inclusive Reservations Required

RSVP by October 30, 2015

$85/person After October 31st, 2015

Annual Gala

Crossroads Regional Chamber of Commerce

Credit Card Information

[ ] VISA [ ] MASTERCARD [ ] AMERICAN EXPRESS [ ] DISCOVER

Name _______________________________________Exp _____________

Credit Card No. _________________________ Security Code ____________

Cardholder Billing Address ________________________________________

City_______________________________ State ________ Zip __________

Signature ____________________________________________________

SPONSORSHIPS

$2000 Classic & Dry

• Includes name in ad and program book plus 10 reservations.

Additional reservations only $65.

$1000 Olives & a Twist• Includes name in ad and program

book plus 8 reservations. Additional reservations only $65.

$500 Top Hat & Tails• Includes name in ad and program

book plus 4 reservations.

$250 Vermouth• Includes name in ad and program book

plus 2 reservations.

All sponsorships must be paid by October 30th to be in ad.

Donate an item or a gift certificate.

All sponsors and silent auction donors will have their company name shown all night on a PowerPoint presentation.

Call the Radisson Hotel and ask for their special Crossroads Regional ChamberGala $89 room rate. 1.800.333.3333 ext. 1234 - Book before October 30th

Created by CONTOUR MEDIA • www.contourmediallc.com