2020 Annual Banquet Registration Name* First Last Phone*Email* Address*[where you want tickets mailed to] Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I would like to reserve a table of 10*All tickets must be pre-paid to reserve all 10 spots. Make sure the sum of all adult tickets, youth tickets, and child tickets are at least 10.YesNoAdult Ticket Price: $60.00 Quantity: Youth Ticket - Ages 13 to 18 Price: $25.00 Quantity: Children Ticket - Ages 12 and under Price: $0.00 Quantity: Names for Each Ticket* Additional Contribution*Please note: We are a section 501(c)(3) charitable organization. Contributions are tax deductible. Any amount you care to give to help sponsor the fundraiser would be gratefully appreciated. Total $0.00 Gold Sponsorships will be sold the night of the event for $250. Sponsors will be entered into a special drawing. One name will be drawn for every five sponsorships sold. Winners receive a $500 prepaid Visa card. Yes, I intend to purchase a gold sponsorship at the event. Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name
