NAACP Dane County 2021 Freedom Fund Ticket Order Form

NAACP DANE COUNTY 2021 FREEDOM FUND DINNER TICKET ORDER FORM

The Madison Concourse Hotel & Governor's Club - Saturday, September 18, 2021
Reception: 5:30 p.m. - 7:00 p.m. - Dinner: 7:00 p.m. - 9:00 p.m.
Adult Ticket
Young Adult (18-25 yrs.) or Life Member Ticket
Youth Ticket (12-17 yrs.)
Total Number of Tickets
Total Cost
PRESENCE: This year's event will be held in-person as well as virtually. Both options include dinner and a one-year NAACP membership, either new or renewal. Please tell us how you plan to attend.
Attendance Preference
VIRTUAL ATTENDEES: Your "To-Go" Meal will be packaged and available for pick-up at The Concourse Hotel, 1st floor Assembly Room on Saturday, September 18, 2021, from 5:30 - 6:30 p.m.
DINNER: Do you have a meal preferance?
Dinner Preference

Other
MEMBERSHIP ACTIVATION
Membership Type
Renewing Members
Current Membership Number (If Known)
CONTACT INFORMATION
Your Name

First NameLast Name
Phone Number

Area CodePhone Number
Your E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PAYMENT

Make Checks Payable to:

NAACP Dane County #36AB

P.O. Box 44366

Madison, WI 53744

Attn: Freedom Fund Committee
Should be Empty:

NAACP DANE COUNTY 2021 FREEDOM FUND DINNER TICKET ORDER FORM