VIA Black Gala Form with Payment

Black Legacy Gala

Register for the event by completing the form below.
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Number of people attending*
Select number of tickets:*
prevnext( X )
General Admission
$25.00 Quantity

Total

$0.00
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The payment is ready! It will be completed once you submit the form.
Payments are processed through PayPal. You may pay using an existing PayPal account, or any major credit card / debit card. You must press submit to complete registration. Contact Jacqueline Bell Smith at jacquelinedsmith@bellsouth.net for other registration options.
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Black Legacy Gala