2022 Convention Scholarship Payment Form

Please know that members still need to be registered individually.

Name of Sponsoring Organization *

Your Name *

First Name Last Name

Phone Number *

Please enter a valid phone number.

Email *

example@example.com

Are you open to providing additional funds to support transportation barriers to ensure members' successful attendance?

Yes, please contact me No, not at this time

Below, please let us know the name of each person for whom you are providing a scholarship and for which plan type you are paying:

First Person Name:

Name

First Person Convention Plan Type:

Custom Amount

Total amount you are paying for Person #1 (plan and dues):

Second Person Name:

Name

Second Person Convention Plan Type:

Custom Amount

Total amount you are paying for Person #2 (plan and dues):

Third Person Name:

Name

Third Person Convention Plan Type (optional):

Custom Amount

Total amount you are paying for Person #3 (plan and dues):

Fourth Person Name:

Name

Fourth Person Convention Plan Type:

Custom Amount

Total amount you are paying for Person #4 (plan and dues):

Fifth Person Name:

Name

Fifth Person Convention Plan Type:

Custom Amount

Total amount you are paying for Person #5 (plan and dues):

Sixth Person Name:

Name

Sixth Person Convention Plan Type:

Custom Amount

Total amount you are paying for Person #6 (plan and dues):

Seventh Person Name:

Name

Seventh Person Convention Plan Type:

Custom Amount

Total amount you are paying for Person #7 (plan and dues):

Eighth Person Name:

Name

Eighth Person Convention Plan Type:

Custom Amount

Total amount you are paying for Person #8 (plan and dues):

Total amount you are donating today for the above attendees:

Please know that members still need to be registered individually.
If you have any questions, please contact:
Robert Martin at 206-660-9236 or robert@pfow.org.

Payment Date: *

Month Day Year

This amount will be charged to your card:

USD Description

Credit Card

Thank you very much for your generous support of People First of Washington. If you have any questions, please contact Robert Martin at 206-660-9236 or robert@pfow.org.