Full Name
*
First Name
Last Name
Suffix
E-mail
*
example@example.com
Phone Number
*
XXX-XXX-XXXX
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
*
prev
next
( X )
Individual Ticket
$
75.00
Quantity
Waltz Sponsor
Includes 4 tickets to the event, listing on Facebook pages (Face Autism/Dynasty Dance Clubs), special recognition at the event, name in the program.
$
1,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
Salsa Sponsor
Includes 6 tickets to the event, listing on Facebook pages (Face Autism/Dynasty Dance Clubs), special recognition at the event, name in the program.
$
2,500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Tango Sponsor
Includes 10 tickets to the event, listing on Facebook pages (Face Autism/Dynasty Dance Clubs), special recognition at the event, name in the program.
$
5,000.00
Quantity
1
2
3
4
5
6
7
8
9
10
Please List Guests
Please put one name per line.
Enter the message as it's shown
*
After hitting submit you will be redirected to PayPal to complete your transaction.
Submit
Should be Empty: