Garden Dinner Party Form

5:30–6:30 pm: Meet & Greet at the Mullin’s Farm, 4300 St. Rt. 370,
to receive your Host dinner location/directions.
6:45–9 pm: Dinner at a Host Home.
$65.00 per person ($55 is tax deductible)
RSVP by June 9, 2023
(Seating is limited so please register early)

Please include all persons in your party, limit six, in the same envelope with payment. We will do our best to accommodate your request. All participants must be fully vaccinated.

Submit the form below and pay by credit card (info below) or by cash or check by mailing to or dropping off at the Senior Center, 227 Xenia Ave., Yellow Springs, OH 45387.

Questions? Call 937-767-5751 or email info@ysseniors.org.

* Indicates required field

Contact Name *

First

Last

Email *

Number of additional guests *

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Name *

First

Last

Number of Vegeterians *

Number of Vegans *

Number of Gluten Free *

Other Dietary Restrictions *

Please note any physical limitations of your party *

Will everyone in your party have had a Covid vaccine since Sept. 2022? *

.Yes .No

Payment has been made by: *

.Credit Card (through PayPal, see below) .Check sent to YSSC

Submit

To pay online using a credit card:

Click on the donate button. Type in the amount you want to donate.
In the drop down menu, please specify that this donation is for a Fundraising Event
If you'd like to help cover the processing fee that the YSSC pays in order to accept credit cards, select that option.
Select whether you want to pay with your PayPal account or with a credit card
Please click the box to share your address and add your contact information so we can acknowledge your gift.
If you inadvertently send the money without mentioning what it is for or sharing your email address, send an email to info@ysseniors.org.