2026 Trivia Night Registration

Trivia Night Registration
The Trivia Night for Autism is a fundraiser and community autism awareness event. Grab friends, family and co-workers and join us for a fun night of trivia. Bring your own food and drinks, decorate your table, and dress up like your favorite pop icon. There will be a silent auction, raffles and a 50/50 drawing. Early bird $200 for a table of 10, $35 for a single ticket and $60 for couple. Increases after February 1 to $250 per table, $45 single and $70 for a couple. Pizza can be pre-ordered and raffle tickets can be purchased with registration.

Location:   Jewish Community Center Staenberg Complex

                2 Millstone Campus Dr, Creve Coeur, MO 63146

Date:        April 24, 2026 Doors open at 6 p.m. and Trivia Starts at 7 p.m.
Participant Information:
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Team Name*
Number of Participants
Up to 10 people per table

Team Members

	Name	Email Address
Participant 1
Participant 2
Participant 3
Participant 4
Participant 5
Participant 6
Participant 7
Participant 8
Participant 9
Participant 10

Special Accommodations
Payment Method

CheckCashOther
Signature

Clear
Terms and Conditions:
- By submitting this form, I acknowledge that I have read and agree to abide by the rules and regulations of the Trivia Night event.
- I understand that the registration fee is non-refundable.
- I consent to the use of my information for event-related communication purposes.
- I understand and consent to my photo be taken at this event that may be used for promotional purposes and I will advise the members of my team of the same.
- I will provide the contact information of my team members via email prior to the event to info@freddiefordfamilyfoundation.org.

Registration Type*

Team Registration- Early Bird Early Bird before February 1

$200.00

Individual - Early Bird Registration for 1 person before February 1.

$25.00 Quantity

Couple - Early BirdRegistration for 2 before February 1.

$45.00 Quantity

Team Registration February 1

$250.00

IndividualRegistration for 1 person

$35.00 Quantity

CoupleRegistration for 2.

$60.00 Quantity

50/50 Tickets - 3 for $1Purchase 3 tickets for $1.

$1.00

50/50 Tickets - 10 for $5 Purchase 10 tickets for $5.

$5.00

50/50 Tickets - Arms Length for $20 Purchase an arms length of tickets for $20.

$20.00

Pepperoni PizzaPre-order a large pepperoni pizza.

$15.00 Quantity

Sausage PizzaPre-order a large cheese pizza.

$15.00 Quantity

Cheese Pizza Pre-order a large cheese pizza.

$15.00 Quantity

Veggie Pizza Pre-order a large veggie pizza.

$15.00 Quantity
Item subtotal:$0.00

Mulligans 3 for $103 mulligans for $10.

$10.00

Enter coupon

Total

$0.00

Payment Methods

Credit Card

Cash App Pay

Date Signed

MonthDayYear
Date
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