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* 1. Your Name:

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* 2. Business Name:

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* 3. I plan to attend the 3rd Annual Chamber Membership Awards Banquet on June 13th

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* 4. How many tickets would you like to purchase? (Note: Nominees receive one complimentary ticket - please do not include that ticket in your ticket purchase number)

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* 5. # of Cranberry Walnut Stuffed Chicken

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* 6. # of Haddock Piccata

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* 7. # of Beef Short Ribs

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* 8. Payment Method:

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* 9. Comments:

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