Today's Date
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Month
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Day
Year
Date
Name
*
First Name
Last Name
Age
*
Parent/Guardian #1 Name
*
First Name
Last Name
Parent/Guardian #2 Name
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you ever attended our Charity Ball event in the past?
Number of People in your family/group that plan to attend the Charity Ball on Saturday, November 7th?
Will you attend the VIP Recipient Family Dinner & Pink PJ Party on Friday, November 6th from 5-9pm?
Would you like to participate in the Runway Show at the Charity Ball (not required, however most recipients love to!)?
How many members of your family use the Shuttle Service to/from the hotel to the Charity Ball event venue on Saturday, November 7th?
Do you have any food allergies?
Will you be flying or driving in for Charity Ball weekend?
Do you have a CWHL recipient family you would like to sit with or nearby at Charity Ball?
Questions, Concerns,or Comments?
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