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Fairfax Federation Citizen of the Year Banquet RSVP for 14 November 2021
To pay for your reservation, please either use the PayPal button below or mail a copy of this printed form with a check made payable to FCFCA to:
Attention: Citizen of the Year Banquet
P.O. Box 3913
Merrifield, VA 22116-3913
Please enter your information below, print out a copy for your records (landscape mode) and then click the SUBMIT button below to submit your reservation form.
  Submitter:  Email address:  Phone Number: 
  Company/Affiliation Address
Attendees/Cost Name Dinner Choices: (Please indicate a meal choice for each attendee)
1 $ 55 Chicken Beef Salmon Vegetarian
2 $110 Chicken Beef Salmon Vegetarian
3 $165 Chicken Beef Salmon Vegetarian
4 $220 Chicken Beef Salmon Vegetarian
5 $275 Chicken Beef Salmon Vegetarian
6 $330 Chicken Beef Salmon Vegetarian
7 $385 Chicken Beef Salmon Vegetarian
8 $440 Chicken Beef Salmon Vegetarian
9 $495 Chicken Beef Salmon Vegetarian
10 $550 Chicken Beef Salmon Vegetarian
 1. With which honoree's group would you prefer to be seated? Lance Beets Sharon Bulova John Cook JoEllan Frasch Paul Hammack Cathy Hudgins Dorothy Keenan James Migliaccio Jeffrey Parnes Lisa Sales Holly Seibold Linda Smyth Federation Other No affinity
 2. I am unable to attend however I wish to help defray the Fairfax County Citizen of the Year Awards Banquet in the amount of: $
 3. Opportunities to be a sponsor of the Fairfax County Citizen of the Year Awards Banquet are explained here.
 4. If paying by check, please mail a copy of the printed form with your check made payable to FCFCA to THE FEDERATION, Attention: Citizen of the Year Banquet, P.O. Box 3913, Merrifield, VA 22116-3913.
 5. If you are completing this form after 9 November, do not mail a check, instead pay using PayPal below. After submitting your reservation electronically, please call 703-424-2956 to confirm your reservation (Payments cannot be accepted at the banquet).
 6. Tickets will be held at door.
Please print this page landscape mode using your printer's properties box
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