2021 HPJC Peacemaker Awards Reservation Form

Sign up below for the

2021 Peacemaker

Awards Ceremony

Choose either to attend in person or to watch online.

SUNDAY, November 7th

Find information about this year's Peacemakers HERE

Due to COVID-19, the in-person event will require:
* limited seating and social distancing

* masking (except while eating)
* Covid vaccinations

Please make an extra donation to support

Houston Peace & Justice Center

and My Brother's Keeper.

Learn about the work of HPJC.

Learn about the work of My Brother's Keeper.

Proceeds from the Peacemaker Awards Ceremony are

HPJC's major funding for 2022.

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The recommended payment for the in-person event reservations is $50 per person. The recommended donation for viewing the ceremony online is $25. These amounts will cover only the costs for reception food and beverage catering as well as other expenses for the awards ceremony and the online video production.

However, we want to make the ceremony available to all. You may enter a different amount below after you choose in-person or online.

In order to raise funds for the coming year, please consider helping Houston and Peace and Justice Center (HPJC) and My Brother's Keeper (MBK) by making additional donations. This year HPJC and MBK offer special benefits such as program booklet ads/recognition and free reservations with reserved, in-person seating. Please see details at the event page.

In order to get program booklet advertisements and other acknowledgements, please donate at the underwriter level ($500 or more in addition to the basic registration fees) by October 21. Underwriters will be contacted for information regarding advertisements and acknowledgements.

Note: Your reservations and payment are not recorded until you click on the red Submit Registration button at the bottom of this form.

Choose one of the following ways to celebrate the work of this year's honorees:*

At the in-person Peacemaker Awards Ceremony Program and ReceptionZoom access to view the Peacemaker Awards Ceremony ProgramI can't participate in-person or virtually, but I want to support the work of HPJC and MBK with an extra donation.

Do you want to support the work of HPJC and MBK with an extra donation as well as make in-person or Zoom reservations?

YESNO

Please select an extra donation level. $500 or more makes you an underwriter with benefits as noted above.

Other donation amount:

List how you'd like to be recognized in our awards program - give your name(s), either person(s) or organization, or leave blank to be anonymous

example: ABC family, or XYZ Organization

I would like my underwriter donation to be allotted as follows:

HPJC onlyMBK onlySplit equally between HPJC and MBK

Number of in-person reservations (including yourself)

Please Select

Subtotal for In-Person Reservations (enter a different amount if you wish)

Zoom access recommended donation amount

Enter a different dollar amount if you wish

Your Name*

First NameLast Name

Your Email address*

example@example.com

Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Mobile Phone Number

Home or Work Phone Number

Please let us know who your guests are, so we can have name tags for them and let them, as well as you, know about any event updates. If you do not have this information now, please email it as soon as you can to director[at]hpjc.org. You do NOT need to include yourself here - just your guests.

	First Name	Last Name	E-mail Address
Guest 1
Guest 2
Guest 3
Guest 4
Guest 5
Guest 6
Guest 7
Guest 8
Guest 9

I want to join HPJC or renew my annual membership or renew my organization's annual membership. Add the following amount to my payment total.

$35 individual membership$50 family membership$45 organization membershipNo, not now

Name of your family member

First NameLast Name

Email of your family member

example@example.com

Name of the organization

Total Amount to Pay

Because online credit card charges that can be up to 3%, we would prefer to receive check payment if you are making underwriter donations.

See below for mailing information, if you select pay by check.

CHOICE OF PAYMENT METHOD I will pay by:

checkcredit/debit card

Make checks payable to HPJC, and mail to PO Box 66234, Houston, TX 77266-6234, along with a print out of this completed form.

Your credit or debit card payment will be processed securely by Stripe.

Total 2021 Awards Ceremony Donations/Membership

USDPeacemaker Awards-donations-membership total amount

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Comments

Anything else you want us to know

IMPORTANT: No matter which payment method you have chosen or if you are not making a payment, be sure to click on the "Submit Registration" button below to record your registration for the Awards Ceremony. Clicking on "Submit Registration" will also record your credit/debit card payment, if you chose that payment option.

Thank you for your support of HPJC. Watch for an email message with information regarding attending the Awards Ceremony or with a link to view it via Zoom.