Thank you for considering partnering with us. If you would like to attend the banquet and/or sponsor a table(s), please complete this form.

If you are sponsoring a table(s), once you’ve completed the form, please complete your donation at the link below or mail a check made out to “The Potter’s House.” Please send to PO Box 507 Brownstown, PA 17508 (Please note “Table Sponsor” on the memo line.

Name

First Name

Last Name

Email

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Please choose from the selections below:

I will fill the 8 seats at my table

I will fill __ seats at my table, you may fill the rest (specify in the box below)

I would like for Potter's House to fill all the seats at my table

I would like my sponsorship to be recognized as (specify name of family or company in the box below)

I will send my logo to donordirector@pottershousepa.org

I choose to remain anonymous

I would like to attend without sponsoring a table

Specifications

How many seats will you fill at your table?

Specifications

If you want your sponsorship to be recognized as a specific name or company, please share below:

Specifications

If you are attending and not sponsoring a table, please comment how many seats you need and if you are connected to a registered sponsor

Method of payment

Online - Credit Card (Button Below)

Mailing a Check

online donation / payment

Please designate your donation to “Banquet Table Sponsor” from the drop down.

Thank you for your sponsorship. Please direct any questions to Lanny Millet at donordirector@pottershousepa.org or call 717-919-0316.