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Name(s) *
First Name
Last Name
Address *
Address Line 1
Address Line 2
City
State
Zip
Email *
Phone # *
Seat Reservation
x $40.00
Enter # of seats
Table for 8
x $300.00
Enter # of tables
Donation (tax deductible gift)
x $1.00
Enter an even dollar amount
A Message to Vine House
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