DINNER FOR STUDENTS & Young Adults First Name Last Name Address City Province Postal Code Phone Email 1st Night (Community Dinner) 2nd Night (YJP Dinner) $10 (I'm Broke) $25 (things are looking up) $36 (I can do the suggested donation) $0 Full Scholarship (I would if I could, Sorry) $180.00 (Silver Sponsor) $360.00 (Gold Sponsor) I Love you guys I want to give you more! Other $ CAD Card Number Expiration Month 1 2 3 4 5 6 7 8 9 10 11 12 Year 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 CVV Code Total Amount to Charge Card
