2023 Holiday Party Order

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Brevard Republican Executive Committee

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At the Space Coast Convention Center

2023 Holiday Party

Email(Required)

First and Last Name(Required)

Phone(Required)

Occupation(Required)

Address 1(Required)

Address 2

City(Required)

State(Required)

Zip(Required)

■ Dinner Options

Dinner Tickets

Price:

Enter total number in your party

Dinner Qty(Required)

Please enter a number from 1 to 10.

Meal choices are:

Prime Rib
Chicken Marsala

Primary Guest Food Choice(Required)

Prime Rib

Chicken Marsala

Total

■ Enter Guest Names

Guest 2 First and Last Name(Required)

Guest 2 Food Choice(Required)

Prime Rib

Chicken Marsala

Guest 3 First and Last Name(Required)

Guest 3 Food Choice(Required)

Prime Rib

Chicken Marsala

Guest 4 First and Last Name(Required)

Guest 4 Food Choice(Required)

Prime Rib

Chicken Marsala

Guest 5 First and Last Name(Required)

Guest 5 Food Choice(Required)

Prime Rib

Chicken Marsala

Guest 6 First and Last Name(Required)

Guest 6 Food Choice(Required)

Prime Rib

Chicken Marsala

Guest 7 First and Last Name(Required)

Guest 7 Food Choice(Required)

Prime Rib

Chicken Marsala

Guest 8 First and Last Name(Required)

Guest 8 Food Choice(Required)

Prime Rib

Chicken Marsala

Guest 9 First and Last Name(Required)

Guest 9 Food Choice(Required)

Prime Rib

Chicken Marsala

Guest 10 First and Last Name(Required)

Guest 10 Food Choice(Required)

Prime Rib

Chicken Marsala

Payment

Pay online

Pay by check

■ Please make your check payable to Brevard Republican Party and mail it to:
Brevard Republican Party
P.O Box 410153
Melbourne, FL 32941-0153

Select Credit Card or PayPal account

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Comments
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Please remember to bring an unwrapped Toys for

Brevard Kids Project

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