Name: *

Contact Telephone Number: *

Email: *

Street Address:

City:

State: choose your state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:

Occasion*
In-home dinner party
Cocktail Reception
Creams or High Tea
Wedding
Ball or Cotillion
Corporate Event or Banquet
Breakfast or Luncheon
Press and Promotional Event
Special Family Gathering
Commencement Celebration
Communion, Bar Mitzvah, Bat Mitzvah
Holiday Dinner
Anniversary Party
Birthday Party
Other

Date Of Event
Month: January February March April May June July August September October November December Day: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year: 2012 2013 2014 2015 2016 2017

Number of Guests
Minimum: Maximum:

Timing of the Event
Start: Finish:

Venue
Not Sure
Savoir Fare Event Room, Round Hill, VA
Bluemont Vineyard, Bluemont, VA
Breaux Vineyards, Purcellville, VA
Briar Batch Bed & Breakfast, Middleburg, VA
Historic Long Branch, Middletown, VA
Lost Creek Winery, Leesburg, VA
Oakland Green Bed & Breakfast, Lincoln, VA
Rust Manor House, Leesburg, VA
The Thomas Birkby House, Leesburg, VA
Private home
Other

Catering Presentation (please check all that apply):
Heavy Hors d'oeuvres
Seated 4-course Meal (soup/salad, appetizer, entrée, and dessert)
Seated 3-course Meal (appetizer, entrée and dessert)
Buffet
Cake Cutting
Other