National Ataxia Foundation Logo
Dinner and Bingo Fundraiser for Ataxia
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Dinner Tickets
$40
Includes dinner and one set of Bingo cards
Please select your meal choice
Meal Choice- gluten free pasta is available upon request
required
Select Option
Spaghetti with rich meat sauce
Fettuccine Alfredo
Gluten free pasta?
Select Option
Yes
No
Guest Information
Would you like to add a guest?
Select Option
Yes
Name of Guest
Guest Meal Choice- gluten free pasta is available upon request
Select Option
Spaghetti with rich meat sauce
Fettuccine Alfredo
Guest gluten free pasta?
Select Option
Yes
No
Second Guest
Would you like to add another guest?
Select Option
Yes
Name of Second Guest
Second Guest's Meal Choice- gluten free pasta available upon request
Select Option
Spaghetti with rich meat sauce
Fettuccine Alfredo
Second Guest gluten free pasta?
Select Option
Yes
No
Third Guest
Would you like to add a third guest?
Select Option
Yes
Name of Third Guest
Third Guest's Meal Choice- gluten free pasta available upon request
Select Option
Spaghetti with rich meat sauce
Fettuccine Alfredo
Third Guest gluten free pasta?
Select Option
Yes
No
fourth guest
Would you like to add a fourth guest?
Select Option
Yes
Fourth Guest's Name
Fourth Guest's Meal- Gluten Free Pasta Available Upon Request
Select Option
Spaghetti with meat sauce
Fettuccine Alfredo
Fourth Guest Gluten Free Pasta?
Select Option
Yes
No
Donation Amount
$
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Donor hereby approves the payment of the charitable donation and/or purchase to National Ataxia Foundation and in the amount set forth herein.
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Please make sure you have indicated how many tickets you wish to purchase and provide payment information before submitting your form.
The receipt you receive will be your admission ticket.
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