Gala Form Update Test

Company

Name/Contact*

First Last

Email*

Billing Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Cell

Fax

How would you like to register?*

Table
Individual Seat(s)
I am unable to attend, but would like to make a tax-deductible donation

Table*

Would you like to purchase additional tables?

Yes, I would like additional Benefactors tables ($5,000 each)
Yes, I would like additional Special Friends tables ($3,000 each)
Yes, I would like additional Partners tables ($3,000 each)

Purchase Additional Benefactors Tables

Price: $5,000.00 Quantity:

Purchase Additional Special Friends Tables

Price: $3,000.00 Quantity:

Purchase Additional Partners Tables

Price: $3,000.00 Quantity:

Also Purchase Individual Seats?

If you would like to register individual seats in addition to your table, you may do so now:

Individual Seat

How many tickets would you like to purchase?

Please find my absentee donation in the amount of:*

Guest names will be needed to check in at the event. Add your names (press the "+" icon to add more):

If you have chosen to purchase more than one ticket, please list the additional ticket holders in the box above. If you do not immediately have your guest list at this time, you call us at 409-899-7555 after you have registered to give us your guest list at a later date.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Total amount to be charged to your card:

$0.00

Please verify for security purposes:

40th Annual Gala (UPDATED)

Also Purchase Individual Seats?