Company Name (if applicable)
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
How you'd like to be listed in the program (if applicable, for sponsors at $275+ level) Deadline for program listing: April 20
*
Tickets, Sponsorships & Donations
Please Select
Regular ticket(s) ~ $125 each. Specify # below.
1 individual sponsorship ticket ~ $275
2 individual sponsorship tickets ~ $550
Feather in Your Hat sponsorship table ~ $1,750
Beret sponsorship table ~ $3,000
Bonnet sponsorship table ~ $5,000
Cloche sponsorship table ~ $10,000
Grand Chapeau sponsorship ~ $15,000
Top Hat Presenting sponsorship ~ $20,000
Regular Tickets (if applicable)
Please Select
1 ticket ~ $125
2 tickets ~ $250
3 tickets ~ $375
4 tickets ~ $500
5 tickets ~ $625
6 tickets ~ $750
7 tickets ~ $875
8 tickets ~ $1,000
9 tickets ~ $1,125
10 tickets ~ $1,250
Total amount to be paid via PayPal from above.
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( X )
USD
Description
Donation only? (I will not attend luncheon.)
Yes
No. I am attending.
Names of Attending (Please list table guests, if applicable.)
*
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
Submit
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