Connecticut State Firefighters Association Memorial Foundation
Memorial Fundraiser Dinner
October 1st, 2018
Reservation Form
Tickets are $50.00 each.
Table of 10 is $500.00
We will support the Connecticut State Firefighters Association Memorial Foundation Program. Please reserve the following:
Number of Tickets:____________________ Number of Tables:_______________________
*Monetary Donation:_________________
Total Enclosed:________________________
*We are unable to attend the fundraiser but would like to make a monetary donation.
________________________________________________________________________________________________________________
(Name of Organization)
________________________________________________________________________________________________________________
(Street or P.O. Box)
________________________________________________________________________________________________________________
(City, State, Zip Code)
Organization Contact:_____________________________________________________________________________________
Contact Phone Number:___________________________________________________________________________________
Contact E-mail:______________________________________________________________________________________________
Please send this form and checks payable to:
Connecticut State Firefighters Association Memorial Fund (CSFAMF)
Connecticut Fire Academy
34 Perimeter Rd.
Windsor Locks, CT 06096-1069
Your tickets will be sent as soon as this form and your payment are received. Thank you for your
support! Any questions, please contact Commissioner Edward P. Urbansky(Ret.) at 860-985-3246
Connecticut State Firefighters Association Memorial Foundation
Memorial Fundraiser Dinner
October 1st, 2018
Reservation Form
Tickets are $50.00 each.
Table of 10 is $500.00
We will support the Connecticut State Firefighters Association Memorial Foundation Program. Please reserve the following:
Number of Tickets:____________________ Number of Tables:_______________________
*Monetary Donation:_________________
Total Enclosed:________________________
*We are unable to attend the fundraiser but would like to make a monetary donation.
________________________________________________________________________________________________________________
(Name of Organization)
________________________________________________________________________________________________________________
(Street or P.O. Box)
________________________________________________________________________________________________________________
(City, State, Zip Code)
Organization Contact:_____________________________________________________________________________________
Contact Phone Number:___________________________________________________________________________________
Contact E-mail:______________________________________________________________________________________________
Please send this form and checks payable to:
Connecticut State Firefighters Association Memorial Fund (CSFAMF)
Connecticut Fire Academy
34 Perimeter Rd.
Windsor Locks, CT 06096-1069
Your tickets will be sent as soon as this form and your payment are received. Thank you for your
support! Any questions, please contact Commissioner Edward P. Urbansky(Ret.) at 860-985-3246
Connecticut State Firefighters Association Memorial Foundation
DONATION FORM
We will support the Connecticut State Firefighters Association Memorial Foundation Program.
Total Donation: ____________________________________
_________________________________________________________________________________________________
(Name of Organization)
__________________________________________________________________________________________________
(Street or P.O. Box)
____________________________________________________________________________________________________
(City, State, Zip Code)
Organization Contact:______________________________________________________________________________
Contact Phone Number:____________________________________________________________________________
Contact E-mail:______________________________________________________________________________________
Please send this form and checks payable to:
Connecticut State Firefighters Association Memorial Fund (CSFAMF)
Connecticut Fire Academy
34 Perimeter Rd.
Windsor Locks, CT 06096-1069
Connecticut Fire Academy
