Greater BucksMont Chamber of Commerce
Event Registration Form

To register for the event below, please enter the number of participants in the Qty field for each event.
(Note: do not press "Enter"; use "Tab" to navigate between fields)

Fields marked with an asterisk * are required.

12/11/20 - Dash In and Dine At Home - Dinner and a Movie
Our amazing member, Commonwealth Senior Living at Wilow Grove, is asking you to join them in showing appreciation for the Greater BucksMont Chamber of Commerce and The Food Pantry at St. John Lutheran in Hatboro by supporting our Dash In and Dine at Home Open House and Fundraiser.

For your $25 dollar donation,you will receive our Chef prepared Lasagna Dinner for two which
will be accompanied by a fresh garden salad, garlic bread and Cannoli for dessert. Included with
your dinner your evening entertainment "Popcorn & A Movie" provided by our Co-Sponsors
Fox Rehabilitation, Southeastern Home Health, BrightStar Care of Lower Bucks and SE
Montgomery County and Compassionate Care Hospice.

PICK UP AT: Commonwealth Senior Living at Willow Grove
1120 York Road, Willow Grove PA 19090 - BETWEEN 4:30 & 6PM - Friday, 12/11/2020

Reserve your meal by December 4
Dinner for Two and a Movie - $25.00
Qty =
x $
= $
First Name *:
Last Name *:
Company Name:
Address *:
City *:   State:   Zip:
Phone *:
Email *:
Email (again) *: