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Reservation Form
"Pink is Beautiful" Breast Cancer Awareness Luncheon & Fundraiser
Island Way Grill - 20 Island Way, Clearwater
Tuesday, October 18th, 2022—10:30 AM to 2:30 PM
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Single Reservation
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Member _____________________________________________________________________(circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi
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Table Reservation
RESERVE TABLES FOR 8 FOR FUNDRAISER. To reserve a table, you must complete this form. Please list the name of
each person that is sitting at your table and their entrée choice. You can attach their check for their lunch or they
can mail lunch check separately to reservations chair Karin Stewart, address below.
Host Member ______________________________________________________________________ (circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi ___ Check ___ Credit Card
Member/Guest 2 ________________________________________________________________(circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi ___ Check ___ Credit Card
Member/Guest 3 ________________________________________________________________ (circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi ___ Check ___ Credit Card
Member/Guest 4 ________________________________________________________________ (circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi ___ Check ___ Credit Card
Member/Guest 5 ________________________________________________________________ (circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi ___ Check ___ Credit Card
Member/Guest 6 ________________________________________________________________ (circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi ___ Credit Card
Member/Guest 7 ________________________________________________________________ (circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi ___ Credit Card
Member/Guest _________________________________________________________________ (circle one below)
Ranch Steak Fresh Catch of the Day Chicken Piccata Shrimp Scampi ___ Check ___ Credit Card
Members--$35.00 Guests--$35.00 Number Attending ____ Total Enclosed $_____
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Phone Number: ________________ eMail: _____________________________________________
Note: We cannot refund money for cancelled reservations after the deadline because of our commitment to the venue providing
our luncheon or program.
Instructions for Mailing in Reservation Form with your Check
Please make checks payable to: Island Estates Women’s Club Send to:
IEWC—c/o Karin Stewart, 225 Windward Island, Clearwater, FL 33767 or you can easily drop it off at her address and place it in the IEWC White Mail Box.
Important: Reservation Deadline is Wednesday, October 12th at 12 Noon.
Or drop off at 31 Island Way, IEWC Drop Box before 5 pm. Closed Saturday and Sunday.
Reservations must be in the Drop Box by 12:00 Noon on the Deadline date.
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To PRINT lunch reservation form and attached your check or checks - Control + P
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