Oregon Club of Portland - Dedicated to Supporting University of Oregon Athletics

First Tech Credit Union Big Green Benefit Registration Form
Please fill out the below information to register for the event. Someone will get back to you shortly.

CONTACT INFORMATION

Name:

Address:

City, State, Zip:

Business Phone:

Home Phone:

E-mail Address:

EVENT DETAILS

Please reserve

member ticket(s) at $120 each

Please reserve

non-member ticket(s) at $120 each

Please reserve

table(s) of 10 at $1200 per table

Please reserve

Distinguished Duck Circle table(s) at $2,750 per table

I would like to purchase

raffle tickets at $30 per ticket

I would like to purchase

raffle tickets at $50 for two tickets

Please seat me with

Please reserve a table under the name of

List your table's ten guests name and addresses:

PAYMENT INFORMATION

Form of Payment:

Forwarding Check

Visa

Mastercard

Total Payment $

Account
Number:

Exp. Date:

Name as it appears on card:

SPONSORED BY

Friday, Sept. 11, 2009
5:30 pm
Tiger Woods Center
Nike World Campus


Ticket Price

Individual	$120
Table of 10	$1,200
Patron Table - includes patron host & guest gifts, Corporate signage	$2,750

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