NVCI Fundraiser Dinner Registration
Please use the form below to complete your reservation. An e-mail confirmation will be sent to you.
Please note: FIelds marked with
*
are required!
Your Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your table sponsored by someone else?
*
Yes
No
Not Sure
Name of Table Sponsor:
blanks
.
Including yourself, how many people are you registering for?
*
Please Select
1
2
3
4
5
6
7
8
Please enter the names of your guests (Do not include yourself)
*
My Products
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next
( X )
Dinner Reservation
$
50.00
Quantity
1
2
3
4
5
6
7
8
Table Reservation
Reserve the entire table for you and 7 of your friends!
$
400.00
Gold Event Sponsor
$
1,000.00
Platinum Event Sponsor
$
2,000.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Submit
Should be Empty: