If you are purchasing INDIVIDUAL TICKETS, please indicate: Number of Tickets: _________ (x $65 per ticket) Name(s) of Attendee(s): __________________________________ _______________________________________________________ Address: _______________________________________________ Phone Number: _________________________________________ If you are purchasing A TABLE (10 Seats), please indicate: Number of Tables: __________ (x $650 per table) Name of Table Host: ____________________________________ Address of Table Host: ___________________________________ Phone Number: _________________________________________ *We would like to be able to offer SCHOLARSHIP SEATS to some individuals who have been personally impacted by Courtside Ministries. If you can help us make these seats available, please indicate: Number of Scholarship Seats: _____ (x $65 per ticket) OR Contribution to Scholarship Fund: $ _________________________ Please make checks payable to “Courtside Ministries� and mail
completed registration form and check by October 17th to: Courtside Ministries 1 N. LaSalle, Suite 600 Chicago, IL 60602 Questions? Call (719) 661-9338 or e-mail courtsidemin@gmail.com