Little Hills Winery "Mayhem In Mayberry" Reservation for 1-23-09
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Name for Reservation
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Address
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City
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State
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Zip Code
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Best Phone Number to Reach You:
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Email Address (for reservation confirmation & updates):
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Number of Parties in this Reservation:
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Eleven
Twelve
We have a Larger Group, please call me.
If you are wanting to sit with/near another Party, please provide the Last Name on their Reservation.
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Please tell us how you learned of our Event:
If a Server, please tell us who:
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I give the Winery permission to add my email address to their email distribution for updates or changes to this and future events at the winery.
Yes
No
Registration Detail
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Party 1 Name: (First Last)
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Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
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Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 2 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 3 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 4 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 5 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 6 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 7 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 8 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 9 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 10 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 11 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Party 12 Name: (First Last)
Meal Choice:
Grilled Chicken Breast
Beef Medallions
Vegetarian Plate Requested
Do you have Food Allergies or Special Dietary Needs?
Yes
No
If Yes, please explain:
Payment Information
Advance payment for your party is required in order to secure your reservation. Should you need to cancel or adjust your reservation, contact Julie Eudy at 314-960-6144.
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CANCELLATION POLICY:
Payment for your party will be processed on the credit information provided. Should you need to cancel your reservation, requests received by 5:00 pm on Tuesday, January 20th will receive a complete refund. Beginning January 21st, any cancellations will receive their refund in the form of a Little Hills Gift Card which can be redeemed at the Restaurant or Wine Store.
I have read and understand this policy.
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Please secure a reservation for a party of:
One at $34.95
Two at $69.90
Three at $104.85
Four at $139.80
Five at $174.75
Six at $209.70
Seven at $244.65
Eight at $279.60
Nine at $314.55
Ten at $349.50
Eleven at $384.45
Twelve at $419.40
By selecting to proceed, you will be directed to continue to online payment through PayPal.
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Indicates Response Required