For credit card and check payments, please complete the form below.
Lost Afternoon Rugby LuncheonI/We would like to be an underwriter at the following level (check box).
ATTENDEE INFORMATION *requiredAttendee Name *Name as it would appear on badge *Company/OrganizationClubGUEST NAMES
(Required for name badges put one name on each line)
CONTACT INFORMATIONEmail Address *Please re-type your Email Address *Cell Phone (include area code)Work PhoneAddress 1Address 2City
$2,500 – SUPPORTING SPONSOR
$1,000 – CORPORATE/CLUB TABLES OF 10
$110 – INDIVIDUAL TICKETPlease reserve Number of Seats1234567891011121314151617181920 seats at $110. Seating First Come First Served.
FRIEND OF HOUSTON YOUTH RUGBY ASSOCIATIONI am unable to attend but would like make a donation of $