Manitoba Aboriginal Youth 
Achievement Awards

Date of Event:
November 24, 2011 at 5:30 p.m.
Victoria Inn, 1808 Wellington Avenue, Winnipeg MB

Date:                                              

Purchased by:
Company: Name:                                                                                                                                                    

Contact: Name:                                                                                                                                                       

Title:                                                                                                                                                                       

Address:                                                                                                                                                                 

City:                                                                Postal Code:                              

Phone:                                     Fax:                                   Email:                                                                                    

MAYAA Invoice #: 2011-2[an error occurred while processing this directive]

Your PO #:                                          

Tax receipt required?  Yes        No


Payment Type:   Cheque #                                Money Order #                                Cash

Ticket Cost: $90.00 ($720 per table of 8)

   We are purchasing tickets for our use.

# of tickets                        x $90.00 =                       

   We are donating tickets for Aboriginal youth to attend.

# of tickets                        x $90.00 =                       

  We are not able to purchase tickets, but please accept this donation to the MAYAA.

Total Payment Enclosed: $                           

Optional:
Send these donated tickets to

                                                                                                         

                                                                                                         

                                                                                                         

                                                                                                         

                                                                                                         

Make cheque or money order payable to the Manitoba Aboriginal Youth Achievement Awards