The Greater Philadelphia Area Illini Club

First Name: ________________________ Last Name: __________________

Street Address: _________________________________________________

City: ____________________________ State: ______ Zip:_______________

Phone: _________________________

Email: _________________________

Event: _________________________

Quantity of Tickets: _______________

Payment Submitted: ______________

		    [ ] Enclosed check made payable to Greater Philadelphia Illini Club 

Please mail event form with payment to Greater Philadelphia Illini Club, c/o Alumni Events, P.O. Box 42197, Philadelphia, PA 19101.

Please do not send cash. Thank you!