CCRC Event Registration Form

Event Registration

April 17, 2024 | 11:30 am to 1:15 pm

Forsyth County Country Club 3101 Country Club Road Winston Salem, NC 27104

***Last Registration Day - April 10, 2024 ***

To Register for Luncheon: Fiil out Meal Preference and Submit Payment

Register information
Register Information

Please fill name and contact information of attendees.
Name*

First NameLast Name
Email Address*
example@example.com
Contact Number*
Please enter a valid phone number.
Will you be joining us April 17th 2024?

YesNo but I would still like to support (please see donation section)

Donation
Please view the donation form below.
Donate Today!

Please fill out Sponsorship info
If you chose a sponsorship, please fill the information out below:
Please select which sponsorship you would like to choose.

Platinum ($10,000)Outstanding ($5,000)Distinguished($2,500)Exceptional($1,000)Magnificent($500)Excellent($250)
Is this a check payment?

YesNo
Please upload logo here:

Number of Attendees/Meal Preferences
Any specific meal preferences? Or dietary restrictions?

VegetarianChickenOther
Other - please explain

Please list number of attendees:

	Name	Preference	Other Please explain
1
2
3
4
5
6
7
8
9
10
11
12
13
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15
16

Number of Attendees
Would you like to be updated about the upcoming events?

YesNo
Not sure? Would you like to be reminded?

YesNo
Ticket Price ( Please skip to the green submission button below if you choose a check payment)
prevnext( X )
Celebration event Ticket
$60.00 Quantity



Platinum ( Sponsorship Package)
$10,000.00



Outstanding ( Sponsorship Package)
$5,000.00



Distinguished ( Sponsorship Package) 2
$2,500.00



Exceptional ( Sponsorship Package)
$1,000.00



Magnicficent ( Sponsorship Package)
$500.00



Excellent ( Sponsorship Package)
$250.00



Total

$0.00

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Should be Empty: