Pleasant Hill Village

Dinner and Auction

Name________________________________________________________

Address______________________________________________________

City_________________Zip________Telephone____________________

Number of Dinner Tickets______ @ $25.00_________________

Donation $____________or item/s for the Auction __________________

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Is there any other information we can assist you with? __________________________

Please return to Paulette Miller at 1016 W. North St. Girard, Illinois 62640. Thank-you for your support.