Arbor Hospice - Donation Form

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Support Arbor Hospice

Yes, I'd Like to Purchase a Dine & Dash Ticket!

Patron Tickets are $350 each and Benefactor Tickets are $500 each. Each ticket entitles two people to attend and one to "dash." Reserved tables of eight are also available for $1,600. Each table reservation entitles eight to attend and four to "dash" and also includes two bottles of champagne. Only a limited number will be sold.

Use this secure form if you are paying by VISA, MasterCard or American Express and would like to submit your ticket request online. If you prefer, you can mail this form to the Ann Arbor address at right or fax it to: (734)662-9000/Attn: Dine & Dash. You may also call us at (734) 794-5152. Thanks for helping us help others!

I'd like to order Patron tickets ($350 each)

I'd like to order Benefactor tickets ($500 each). Please RSVP by October 22nd so we may list your name(s) in the event program booklet.

I'd like to reserve table(s) for eight. ($1,600 each table)

Enclosed is my payment of $

Ticket Purchaser Information:

Your Name

First Middle Init. Last Name

Street

City

State

Zip

E-mail

Phone

123-456-7890

Credit Card Information

Type

Name on Card

Account #

Expiration Date

Month

Year

Please Check Here If you would like a Vegetarian Dinner Option

I/we would like Vegetarian Meal(s)

Please provide us your name(s) so we may have your name tag(s) ready!

Please list the name(s) of dasher(s). (One dasher per ticket)

Access Center
1-800-997-9266

The Residence of Arbor Hospice
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2366 Oak Valley Drive
Ann Arbor, MI 48103
Phone: (734) 662-5068

Ann Arbor
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2366 Oak Valley Drive
Ann Arbor, MI 48103
Phone: (734) 662-5999
Fax: (734) 662-2330

Downriver
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19145 Allen Rd., #110
Trenton, MI 48183
Phone: (734) 486-4060
Fax: (734) 486-4061

Western Wayne
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331 N Center
Northville, MI 48167
Phone: (248) 348-4980
Fax:(248) 465-1845

Toll-free
1-888-992-CARE