MESS Hall Wine Pull 2018

Name *

First Name Last Name

Company (optional)

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

E-mail *

Payment Method *

Online - credit card or bank transfer Check

When you submit this form, you will be taken to the PayPal site. If you do not have a PayPal account, you may choose to pay with credit card without creating an account.

Ticket or sponsor level *

Individual Ticket(s) - $50 each Silver Sponsor - $500 Gold Sponsor - $1000

Quantity of Individual Tickets *

An Individual Ticket provides admission for one person and one entry in the wine pull.

Silver Sponsor includes admission for 6, six entries in the wine pull, and named sponsorship in the program materials.

Gold Sponsor includes admission for 12, twelve entries in the wine pull, named sponsorship in the program materials, and a sponsor banner.

Individual Tickets

Silver

Gold

Online Multiplier

Total Online Cost

Total Amount for Check

Online Payment

USD Wine Pull Payment

Sponsor Name for Recognition

To smooth admission, please indicate the names of your guests. You may send this list at any time.

Guest Names

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

The Pensacola MESS Hall is a 501(c)3 organization. Our mission is to inspire curiosity, experimentation, and creative problem solving through exploration of math, engineering, science, and stuff.
A copy of the official registration and financial information may be obtained from the Division of Consumer Services by calling toll-free within the state. Registration does not imply endorsement, approval, or recommendation by the state. FDACS's toll-free number is 1-800-HELP-FLA (435-7352). The FDACS website is www.800helpfla.com.

Payment Options