Forever Green
Campaign for Northwest
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Retirement/Farewell Reception Event Request Form

* Indicates required fields.

Client Information

*Who is this reception for?

*Years of Employment:

*Current Title:

*Department or Office:

Lead Contact for the Reception

* Contact Name:

*Phone Number:

*Email Address:

Event Information




*Has location been confirmed?
Yes     No

STOP! You cannot submit this form until the location has been confirmed with Mark Hendrix ( or 660.562.1420).

*Number of Guests Expected:


These are only suggestions based on cost per person for a reception for 75-100 people. Indicate your choices or make requests and the event coordinator will work with the caterer's to stay under the $400 budgeted amount.

 Truffle Balls

*Cake Flavor:
 Half & Half

*Decorations and/or Text on Cake:

 Fruit Tray
 Veggie Tray
 Cheese and Cracker Tray

 Zesty Chex Mix
 Sweet Chex Mix
 Traditional Chex Mix
 Mixed Nuts
 Kettle Chips with Ranch

Hot Dips:
 Crab Rangoo with Wonton Triangles
 Spinach & Artichoke with Pita Chips

Cold Dips:
 Humas with Pita Chips
 Fruit Salsa with Cinnamon Chips


Other Request:

Music Playlist

Make specific song, genre or artist requests:

Decoration Requests

Make decoration requests (theme, balloons, color, etc.):