SLGBTI Annual Dinner 2019 - Registration Form
 
Division 17's Section for LGBT Issues thanks you in advance for your upcoming attendance at our annual dinner.  This year's dinner will take place at 14 Parish, 2333 S Michigan Ave., Chicago, IL 60616 on Thursday, August 8th from 7:00pm until 9:00pm.  This is a Caribbean Fusion restaurant.  
 
The seated dinner price is $50 per person for professionals and $45 per person for students.  
 
Please complete the following registration form in advance of the dinner (no later than July 20th) so that we can make preparations.  If you have any questions about completing the registration form, please contact Tyler Lefevor at tyler.lefevor@gmail.com or Adrian Rodriguez at adrodriguez@fullerton.edu.  
 
Thanks in advance!  We look forward to seeing you there! 
 
Div. 17 SLGBTI Executive Board Members-At-Large
Please enter your name.
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Please enter your email address.
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Please enter your phone number (best number to reach you).  
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Are you a professional or a student?  Please select from the options below. 
If you are a professional and are interested in sponsoring student dinners, please indicate how many students you would like to sponsor by entering a number in the text box.  You can include payment for the student plates as part of your overall payment.  *Please note that you can sponsor a student even if you do not plan to attend the dinner yourself.  

*Please note that professional plates are $50 each, and student plates are $45 each.  

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If you are a student and would like your dinner to be sponsored due to financial need please indicate yes below.

    
*Please note that sponsorship is not guaranteed.  Those students seeking sponsorship should not submit a payment for now.  We will contact you after July 26th to let you know if the cost of your dinner (or a portion thereof) is able to be covered through sponsorship.  

Student plates are $45 each. 
As a reminder, the cost of the dinner for professionals is $50; the cost for students is $45.

 

If you will be paying by check in advance of the dinner, please make the check payable to SLGBTI.  Please put the check in an envelope and mail to the following address:

 

Dr. Kodee Walls

1105 Sunset Ave, Room 101 

Manhattan, KS 66506.

 

If you will be paying by check at the dinner, please make the check payable to SLGBTI and we will obtain the check from you at 14 Parish restaurant.

 

If you will be paying through the Venmo app, please send your payment to the following email: kodeewalls05@gmail.com using the Venmo app. 

 

If you have any additional questions, please contact Tyler Lefevor at tyler.lefevor@gmail.com or Adrian Rodriguez at adrodriguez@fullerton.edu.

 
*Please note that we are not accepting cash payments for this event. 
 
Please select the payment method you will be using below:
 
 
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Dinner at 14 Parish will include:
 

Course One: Soups of the Day Or House Salad

Course Two: Sweet and Spicy Short Rib Or 

                     Portobello Pepper Pot Or 

                     Island Chicken Or  

                     Coconut Curry Shrimp

Course Three: Assorted Cheesecake

Beverages: Soft Drinks, Tea, and Coffee

    
For more details on the menu, please copy and paste the following link into another window: https://www.14parish.com/
 
You will be able to select your choices from the above options on the night of the dinner. 
If you have any food allergies, please list below:
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Do you need gluten-free options?
Do you need vegetarian options?
Do you need vegan options?