Note that above early bird prices will increase to $120 after Sep. 23, 2023.
Attendee Information
First Name
Last Name
Street Addr
City
State
Zip
Phone (123-456-7890)
E-mail
If payer name on credit card will be different from attendee, please fill in below.
Payer 1st Name
Last Name
Please select one from the menu choices below.
Guest Name
(If applicable - Fee will be adjusted.)
Please select one from the menu choices below (if applicable).
If you have food allergies or other comments, please indicate below
If you would like to sit with others, enter up to 3 names below. We may not be able to accommodate all requests.
If you would like to be a "Signature Cocktail" sponsor,
please check the box and select the quantity below.
Quantity at $300 each (names listed in program)
Name of cocktail (Optional)
(Please separate each individual Cocktail & Comment with a semicolon.)
Additional sponsorship questions or comments may be
submitted to Chip at psrochester@ymail.com
Credit card payments will be accepted on PayPal after continuing.
Please check the box below before hitting the continue button.
