Wednesday, September 2, 2015 • Holiday Inn, Skokie 5300 West Touhy Ave • Skokie, Illinois Doors open 7:30 PM, Event begins 8:00 PM How many reservations ? 1 Reservation - $18.00 2 Reservations - $36.00 3 Reservations - $54.00 4 Reservations - $72.00 5 Reservations - $90.00 Personal Information First Name* Last Name* Email* Phone Address Information Address* City* State* Zip* Credit Card Information Card Number Expiration Month 01 02 03 04 05 06 07 08 09 10 11 12 Expiration Year 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 CCV Code Amount: $18.00 $36.00 $54.00 $72.00 $90.00 $180.00 This page uses 128 bit SSL encryption to keep your data secure.
