Quiet Oaks Hospice House - DO Not Use - AR

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Quiet Oaks Hospice House
P.O. Box 1241
St. Cloud, MN 56302
Phone 320.255.5433
Fax 320.240.7962
mailto:quietoaks@gmail.com

Autumn Reflections

Fill out the information below to purchase tickets or provide a Table Sponsorship for Autumn Reflections.

You may also use this page to make a donation to Quiet Oaks.

First Name
Last Name
Company Name, if any
Street Address
City
State
Zipcode
Email
Can we email you at his address?	Yes No
Home Phone
Cell Phone


Level of Table Sponsorship	Table Sponsorship $1000 Table Co-Sponsorship $500
Names of Table Members (optional, at this time):

How would you like to be recognized in the program?
To complete this registration:

1) To pay with a check, print this completed page, include your check, and mail to:
Quiet Oaks Hospice House
PO Box 1241
St Cloud, MN 56302

2) To use a credit card as payment, complete this page and: Click on the button below (your registration will happen at the same time) OR call Elaine Benusa (320) 255-5433 #6 with your credit card details.

First Name
Last Name
Company Name, if any
Street Address
City
State
Zipcode
Daytime Phone Number
E-mail address
Can we email you at this address?	Yes No
Number of Tickets being purchased
Names of Individuals (optional for one ticket/can be submitted later):

To complete this purchase:

Print this form, include a check, and mail to:
Quiet Oaks Hospice House
PO Box 1241
St Cloud, MN 56302

Or, to pay with a credit card, click here:

Thank you very much for your interest in Quiet Oaks!

Quiet Oaks Hospice House
PO Box 1241
St Cloud, MN 56302

320-255-5433
866-717-8438