ORTLEF Dinner Reservation/Raffle Ticket Form Secure Online Reservations Add the quantity for registrations and raffle tickets in the respective boxes. I am purchasing*Auction Reservation onlyRaffle Ticket(s) onlyBoth Reservation and Raffle Ticket(s)Auction Reservations: Price: $53.00 Quantity: Raffle Tickets Price: $10.00 Quantity: For Oregon residents only.Online Raffle Tickets Available: 29 For prizes and rules click here RESERVATION INFORMATIONFull Name* First Last Please enter your credit card billing addressAddress* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* My menu selectionSelect MenuGlazed SalmonGrilled SirloinPasta PrimaveraGuest Information and Menu SelectionsGuests Info and menu selections Guest Name Menu Selection Email Phone Address Actions Edit Delete There are no guests. Add guest Maximum number of guests reached. CommentsPayment InformationPurchase Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. If you wish to pay by another means, please contact the office at 503.463.8563 Mail In Reservation Form