Please send this form to:
Community Services of Stark County, Inc.
625 Cleveland Ave NW
Canton, Ohio 44702

Dinner 1                       Dinner 2
Steak                     Steak

Vegetarian             Vegrtarian

Scrod                    Scrod

        Name ________________________________________________________________

        Address ______________________________________________________________

        City _____________________________ State ____________ Zip ________________

      Please make checks payable to Community Services
      or charge to my credit card
                      Mastercard    Visa       Exp. Date ______/______

                     Card Number _________-_________-_________-________

                      Signature_________________________________________

     Community Services is a 501(c)(3) not-for-profit organization. Contributions
      are tax deductible as allowable by law.