5th Annual

Trivia Night
Trivia Side Games Silent Auction
Saturday February 25, 2017
Doors Open 6:00 pm, Contest Begins at 6:30 pm
Light appetizers, tea, and water will be provided to all players.
Buffet, soft drinks, and adult beverages available for purchase.

Trivia Committee Members

Gina Lanning, West Central IL Special Education Co-Op
OGriffs Grill and Brewhouse
Winters West Wing
415 Hampshire; Quincy, IL 62301
Please RSVP before February 10th
Reservation Information
Name: ______________________________________________
Digitally signed by Joseph P. Clarke
Address: ____________________________________________
Joseph P. Clarke
DN: cn=Joseph P. Clarke, o=Keokuk Steel
Castings, ou=Special Operations,
City/State/Zip: _______________________________________
email=jclarke@keokuksteel.com, c=US
Date: 2017.01.28 00:13:30 -06'00'
David Amelotti, KHQA
Sarah Fernandez, Western IL Pork Producers
Corinne Duryea, Quncy Media
Amy Seeland, Blessing Hospital
Tonya Hurt, Quincy Public Schools
Bruce Venvertloh, DOT Foods
Melissa Harbin, Hy-Vee Pharmacy
Karen Wagner, United Way of Adams County
Scott Luaders, Quincy University
Joy Berhorst, domestics, etc.
Matt Courtney, Great River Firearms Training
Sgt. Brian Dusch, Quincy Police Department
Michael Rose, Town Square Media
Kim Winter, OGriffs Grill and Brewhouse
Shawn Smith, OGriffs Grill and Brewhouse
Sponsorship Levels
[ ] $250 Event Sponsor
Color logo on registration form & website

E-Mail: _____________________________________________ Full color sign at judges table

Phone: _____________________________________________ 3x verbal announcement

[ ] $425 Genius Table
8 Tickets (one full table)
Set of Mulligans
Question Swap
Premier Table Location
Sign at Judges Table
[ ] $150 Smarty-Pants Table
8 Tickets (one full table)
[ ] I am unable to attend. Please accept $______ as a donation.
[ ] $250 Brainiac Table [ ] $175 Silent Auction Table or Mulligan Sponsor
8 Tickets (one full table) Auction: Sign & decorations on a silent auction table
Set of Mulligans Mulligan: ad on all mulligan sticker instruction sheets
Question Swap
[ ] $100 Round or Side Game Sponsor
Round: verbal announcement & ad on answer sheet
Side Game: verbal announcement & ad on slide deck
[ ] $20 Individual Tickets
Qty: _________ [ ] Silent Auction Item Donation
Donated Item: ____________________Value $_________
Donated Item: ____________________Value $_________

Payment Information Please return this form

Check - Payable to Mississippi Valley Council JDavid.Gilbert@Scouting.org
Credit Card Info Gardner Scout Service Center
Card #: _____________________________________________ 2336 Oak St; Quincy, IL 62301
Expiration: __________________________________________ For more information: J. David Gilbert at 217-224-0204
Signature:___________________________________________