2020nHPJC Peacemaker Awards Dinner Reservation Form

Sign up below

to receive your web link to

HPJC's 2020

Peacemaker Awards Ceremony

~~~

SATURDAY, December 5th

2:00 pm - 3:00 pm CST

via Zoom

Please make a donation to

support HPJC's work.

Awards Ceremony donations will be our major funding for 2021.

Name*

First NameLast Name

Please send the awards ceremony link to this email address.*

example@example.com

Phone Number

Area CodePhone Number

Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

To help with HPJC's work in 2021, I am donating:

DONATION ACKNOWLEDGEMENT. NOTE: Names of donors of $100 or more can be acknowledged in the program credits if the donation is received before November 27. Donations amounts will NOT be listed in the credits.

Yes, please acknowledge my donation. I would like to inspire others to support HPJC.No, I would like to remain anonymous.

Name(s) in the acknowledgment:

I would like to take this opportunity to join HPJC, renew my annual membership or renew my organization's annual membership.

$35 individual membership$50 family membership$45 organization membership

In addition to myself, here are names and email addresses of other family members. Or here is the name of my organization and contact information for this organization.

Example entry: Pat Smith psmith@noemeail.com, Terry Jones tjones@noemail.com Or Nonviolence Alliance info@NValliance.edu

CHOICE OF PAYMENT METHOD I will pay by:

checkcredit/debit card

Make checks payable to HPJC and mail to PO Box 66234, Houston, TX 77266 along with a print out of this completed form. Please make check for this amount:

Total amount:

Total Donation/Membership

USDThis amount will be charged to credit/debit card

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

IMPORTANT: No matter which payment method you have chosen or if you are not making a payment, be sure to click on the "Submit Registration" button below to record your registration for the Awards Ceremony. Clicking on "Submit Registration" will also record your credit/debit card payment, if you chose that payment option.

Thank you for your support of HPJC. Watch for an email message with your link to the Awards Ceremony.