*Name or contact person:

Senior Center (if applicable):

*Address:

*City: *State: *Zip:

*Daytime Phone Number:

Fax:

E-mail:

*Total number of people attending:

*Lunch reservation:   Yes   No
If yes, please check lunchtime preference.   11:30   12:15   1:00

Quantity of lunches (at $16 each):

For groups of 10 or more only:
We will arrive   as a group   individually

Please print this form and return it with your lunch payment to:
(Please make check payable to AIC Senior Celebrations)

Senior Celebrations
The Art Institute of Chicago
111 S. Michigan Avenue
Chicago, IL 60603

Please click the Submit Registration button to process your registration.