2005 Phil Olin Dinner Dance

81-15 164 Street, Jamaica, NY 11432
Telephone 718-380-3000, Ext. 324

Please reserve _______ tickets for An Evening of Fine Food to be held on Tuesday, February 5, 2008 at Terrace On the Park, Flushing Meadows - Corona Park, Queens.

Name__________________________________________

Company_______________________________________

Address________________________________________

Telephone_________________________________Fax_________________

E-mail _______________________________________________________

Amount of check enclosed $_________ R.S.V.P. by January 21, 2008

Checks to be made payable to: Queens Centers for Progress and mailed to 81-15 164 St., Jamaica, NY 11432.
All tickets are $125 each and must be paid in advance by credit card or by enclosing a check.

If paying by credit card, please complete the form below:

VISA Master Card American Express (check one)

Name______________________________________________

Card Number__________________________ Expires_________

Amount $_____________ Signature_______________________

10% of your payment may be considered a charitable contribution.