Quail West Gala Reply Card Quail West Gala Reply Card Total Guests Attending(Required)Please enter a number from 1 to 8.Your Full Name(Required) Your Email(Required) Your Dietary Restrictions Guest 2: Full Name Guest 2: Email Guest 2: Dietary Restrictions Guest 3: Full Name Guest 3: Email Guest 3: Dietary Restrictions Guest 4: Full Name Guest 4: Email Guest 4: Dietary Restrictions Guest 5: Full Name Guest 5: Email Guest 5: Dietary Restrictions Guest 6: Full Name Guest 6: Email Guest 6: Dietary Restrictions Guest 7: Full Name Guest 7: Email Guest 7: Dietary Restrictions Guest 8: Full Name Guest 8: Email Guest 8: Dietary Restrictions Payment Type(Required) Online By Phone By Mail Please select your method of paymentYou will receive an email with all of the above information in it. Print the email and include it with a check made payable to: MS Center of SW Florida Mail the check to: MS Center of SW Florida 8200 Health Center Blvd, Suite 104 Estero, Fl 34135 This information will also be included in the email. Call (239) 319-0904 Monday - Friday between 8:30 am and 4:00 pm and ask for Kay or Ann to pay with a credit card over the phone. The information on this form will be sent to the staff so they will have it when you call. To pay online, click submit and a link for online payment will be provided on the next page. Your answers above will be emailed to staff. Δ
