Dinner of A Lifetime Registration:
First name:
Last name:
Email address:
Cell Phone:
Mailing address:
Number of People Expected at Dinner Party:
Would You Like FREE HIV Testing:
Date and Time That You Would Like To Have Your "Dinner of A Lifetime!"
Address of "Dinner of A Lifetime!", if different from above:
Additional Comments:
Recommendation Card: List the Names and Numbers of Individuals You Know Who Will Join In The Fight