Name/Organization:
Address:
Phone:
Fax:
YES, I will attend the NLG Testimonial Dinner. Please reservethe indicated number of tickets	@$90 @$60
I WOULD LIKE TO RESERVE THE FOLLOWING DINNER(S):
	chicken (pan seared chicken breast with youkon whipped potatoes)
	vegetarian (wild mushroom ragout)
I would like to make a tax deductible donation to subsidize low-income clients and community activists. Amount:

create form IMPORTANT. After submitting the form, please click on "continue" to come back to the NLG Mass main page and make your payment.