Jewel Nightclub Table & Bottle Service

Full Legal Name*

Email*

Mobile Number* (for text messages)

Preferred Method of Contact*
EmailText

Event Date* (Month/Date/Year)

Venue*
—Please choose an option—Ayu DayclubDaylight Beach ClubDrais Beach ClubDrais NightclubEncore Beach (Daytime)Encore Beach at NightHakkasan NightclubMarquee DayclubMarquee NightclubOmnia NightclubTao BeachTao NightclubWet RepublicXS NightclubZouk Nightclub---Need Suggestions-DaytimeNeed Suggestions-NighttimeOther

What is your budget?* (This is the total amount you plan to spend on drinks or food while you occupy the table. The higher the budget, the better the table placement and size.)
—Please choose an option—$500 to $1000$1000 to $1500$1500 to $2000$2000 to $2500$2500 to $3000Over $3000

Details* (Number of guys/girls in group, etc.)