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Cheers for CASA Event Registration
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1
Date
Saturday, April 27, 204
Time
6 - 9 p.m.
Address
Junction City, Kansas 66441
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2
Would you like to purchase a team ticket?
*
This field is required.
Yes, 1 Team ticket for 2 people
Yes, 1 Team ticket for 3 people
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3
Team Contact Full Name
*
This field is required.
Please list the name for the team contact person. All check-ins and listings will be listed under this name.
First Name
Last Name
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4
Team Main Contact E-mail
*
This field is required.
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5
Team Contact Phone Number
*
This field is required.
Area Code
Phone Number
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6
Would you like VIP check-in?
*
This field is required.
VIP Check-In will shorten your check-in time and allow you to skip the check-in line so that your team can go directly into the event. The cost is $10/team.
YES
NO
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7
Would you like to purchase an event wine glass?
*
This field is required.
The glass can be used for beverages at the event but is yours to keep. The cost is $5 per glass.
Yes, 3 glasses please.
Yes, 2 glasses please.
Yes, 1 glass please.
No Thank You.
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8
Would you like to enter our Chocolate Cupcake Jewelry Drawing?
*
This field is required.
Please note that only 25 tickets will be sold in total. Each ticket is $20. The jewelry was donated by Zales (Manhattan Mall) and has a retail value of $200.
Yes, 1 ticket please
Yes, 2 tickets please
Yes, 3 tickets please
No thank you
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9
Calculation
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10
Your Total
*
This field is required.
Thank you for your tax deductible donation!
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( X )
USD
+ OR enter a custom value
Credit Card
First Name
Last Name
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Cheers For CASA Registration
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