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35th Anniversary Celebration

35th Anniversary CelebrationHigh Peaks Hospice2022-08-17T12:49:36-04:00

High Peaks Hospice's 35th Anniversary Celebration Dinner

“Celebrating our growth and the families we have served since our beginning.” Please use this form to register and submit your payment. You will then be added to our list of attendees.

Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Your Meal Selection *

Chicken Marsala - Pan Seared with Mushrooms in a rich Marsala Sauce
Pecan Encrusted Salmon - 8oz Fillet topped with an Apple Beurre Blanc Glaze
Pasta Primavera (Vegetarian) - Seasonal Pan Seared Vegetables tossed with Angel Hair Pasta, finished with a Traditional Roasted Garlic Cream Sauce

Are you bringing a guest? *

Yes
No

Guest Name *

First

Last

Guest Meal Selection *

Chicken Marsala - Pan Seared with Mushrooms in a rich Marsala Sauce
Pecan Encrusted Salmon - 8oz Fillet topped with an Apple Beurre Blanc Glaze
Pasta Primavera (Vegetarian) - Seasonal Pan Seared Vegetables tossed with Angel Hair Pasta, finished with a Traditional Roasted Garlic Cream Sauce

Are you bringing a second guest? *

Yes
No

Second Guest Name *

First

Last

Second Guest Meal Selection *

Chicken Marsala - Pan Seared with Mushrooms in a rich Marsala Sauce
Pecan Encrusted Salmon - 8oz Fillet topped with an Apple Beurre Blanc Glaze
Pasta Primavera (Vegetarian) - Seasonal Pan Seared Vegetables tossed with Angel Hair Pasta, finished with a Traditional Roasted Garlic Cream Sauce

Registration Fee for Registrant *

Price: $ 50.00

Registration Fee for Guest 1 *

Price: $ 50.00

Registration Fee for Guest 2 *

Price: $ 50.00

Consider a Donation to Support High Peaks Hospice

Please enter your donation amount above. Even a small donation helps us offset the processing fee which is generally around 3%.

Total Payment

$ 0.00

Credit Card Information *

Card

Name on Card

Save and Resume Later

Your form entry has been saved and a unique link has been created which you can access to resume this form.

Enter your email address to receive the link via email. Alternately, you can copy and save the link below.

Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted.

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Email *

Question? Please contact the High Peaks Hospice Event Specialist, Debi Buttino, at 518-891-0606. Thank you!

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