Women's Dinner Party - Fenway Health


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TABLE CAPTAIN REGISTRATION FORM

Thank you for your support of Fenway Health and your interest in becoming a Table Captain at The Women's Dinner Party. This year's event will be held Saturday, April 6, 2013 at the Boston Marriott Copley Place from 6 p.m. to 1 a.m. We expect more than 1,200 women and their supporters, volunteers and political and community leaders to attend.

All Women's Dinner Party tables seat 12 people. Tickets to this year’s Women's Dinner Party are $200 each and tables cost $2,400. Purchase your tickets by December 31, 2012 and pay a discounted rate of $175 per ticket and $2,100 per table.

Tribute Tables
Fenway Health offers you a high-visibility naming opportunity in which you can pay tribute to someone who has made a difference in your life (a loved one, a role model, a colleague, political figure, celebrity, author, historical figure or anyone you wish to honor). Contact Niamh Foley at nfoley@fenwayhealth.org for more information.

Table Captain Registration Form Purpose:

Register as a 2013 Women's Dinner Party Table Captain
Ensure that your name is properly listed in the Women's Dinner Party program materials
Receive invitations to The Women's Dinner Party Table Captain Parties
Register as soon as possible
Table must be paid in full by Friday, March 22, 2013. You will have the opportunity to pay for your table, if you wish, after you register.

Instructions:

Please fill out the form below. Please allow 24-48 hours for your name to appear on the Table Captain pull-down list on The Women's Dinner Party ticket purchase page. If you have any questions or wish to have your guests purchase tickets by phone, please call 617.927.6350.

Please tell us about yourself.

If you have previously registered, please login here to prepopulate your information.


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*	First Name: Required
	Middle Name:
*	Last Name: Required
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*	Email: Required
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*	City: Required
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	If you respond and have not already registered, you will receive periodic updates and communications from Fenway Health.
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Phone number(s) we can use to contact you:

Question - Not Required - Work:

Question - Not Required - Home:

Question - Not Required - Cell:

Question - Not Required - Which phone number would you prefer us to use? Work
Home
Cell

Question - Not Required - Twitter username

Question - Not Required - Let us know how you would like your name to appear in the program book. If you want to co-captain with your spouse, partner, or a friend, please include his or her name.

Question - Not Required - I will be a Table Captain for the following number of tables:

Question - Not Required - Will you be attending The Women's Dinner Party Table Selection Party Wednesday, March 27, 2013 (location TBD)? All registered Table Captains are invited to attend. Tables will be chosen in the order in which they were paid. Yes, I will attend.

By agreeing to be a Table Captain I understand that I should contact Fenway Health by Friday, March 22, 2013 if I have open seats at my table so that Fenway can assist in filling the open seats.