Gala Registration appealNameRegistration InformationWhich Gala Registration level would you like to choose?*Gold ($1000)Silver ($250)How many people will you be registering today?*12345678910Do any of your attendees need accessible seating?*YesNoPlease give details (wheelchair seating, no steps, etc)Additional DonationWould you like to make a donation in addition to your registration?YesNoTHANK YOU! Please enter your donation amount below.* (Include dollar amount only - no $ sign. If you would like to help cover the credit card fees, they are about 3% of the total.)Payment InformationTotal $0.00 Billing InformationName* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Credit CardCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name CAPTCHA Your charitable contribution may be tax deductible to the extent your contribution exceeds the value of any good or services received in connection with the contribution. A Gold Registration is valued at $150 and a Silver Registration is valued at $100. You should receive a confirmation email shortly after submitting your registration. If you do not receive this confirmation, please contact Tonya Gillham at email@example.com NameThis field is for validation purposes and should be left unchanged.