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Medical Relief For Haiti!  Fundraiser for


providing medical care in Haiti since 2002
Sponsored by:
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and
$25.00 dollar donation in advance, using the form below.  $30.00 at the door.


Vlada Lounge
331 W. 51st Street
New York, New York

Friday, February 12th from 6 to 8 PM
Free Vodka Drinks from 6 PM to 7 PM
Free Rum Drinks from 7 PM to 8 PM
All donations will go to help NOVA Hope for Haiti provide medical relief in Haiti.

Name

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Address

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City

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State

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Zip

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Phone

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Email

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Number of Tickets @ $25 each.

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