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Benefit Banquet Reservation
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Guest Name*
FIRST - LAST
Company
E-Mail *
Please save paper, use email as my primary method of correspondence.
Address *
Apt./Ste. *
City-State-Zip *
Phone *
Alt Phone
Guests *
1 @ $50
2 @ $100
3 @ $150
4 @ $200
5 @ $250
6 @ $300
7 @ $350
8 @ $400
9 @ $450
Table @ $500
Corporate Table @ $700 ($480 Tax Deductible)
Guest 1:
Guest 2:
Guest 3:
Guest 4:
Guest 5:
Guest 6:
Guest 7:
Guest 8:
Guest 9:
Guest 10:
Each Individual Ticket Includes a $28 tax deductible donation
Corporate Table Sponsorship $700 (includes $480 donation and sponsor benefits. Contact us for details.)
Wheelchair Required
I would like to donate to the Auction/Mystery Gifts. Gift:
Please contact my employer about Corporate Tables. Employer:
Please list you name as you would like to be acknowledged:
Please list any special needs:
Additional comments:
AMOUNT DUE * $
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Portland Taiko
3230 NE Columbia Blvd.
Portland, OR 97211-2032
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