Title Family Name Given Names

Address (Private) Phone (Private) Mobile

Postal Code City Country

Company Phone (Office) Email

Day and month of birth

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Food Restrictions

I shall be accompanied by: Title Full Name

Day and month of birth

Food Restictions

Please note prices are in $USD

Individual : $1,000 Couples: $1,800 Tables (10 people): $10,000

Additionally I enclose a Donation of $ to the Totalprestige Cultural & Professional Foundation

Generous Donators (over $100) will be listed on the London Gala Official Brochure.

Total Amount $

I would like to pay by:

Bank Transfer Pay Pal

Bank details will be provided after reception of this confirmation. Invoices for tables on demand. Send complete guest list to Rose@totalprestige.com. Pay Pal payment (credit card) possible.

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