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Gala 2024 Registration
Organization or Individual
*
Organization
Individual
Organization/Employer
(As you wish to be listed for recognition)
Contact Information
Name
*
First Name
Last Name
Email
*
Verify Email
*
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Ticket Package
*
Quantity
$10,000
-
Diamond
0
1
2
3
4
5
6
7
8
9
10
10
$7,500
-
Platinum
0
1
2
3
4
5
6
7
8
9
10
10
$5,000
-
Gold
0
1
2
3
4
5
6
7
8
9
10
10
$3,000
-
Silver
0
1
2
3
4
5
6
7
8
9
10
10
$1,700
-
Bronze
0
1
2
3
4
5
6
7
8
9
10
10
$200
-
Individual Ticket
0
1
2
3
4
5
6
7
8
9
10
10
Add 3% to my total amount to help cover the payment processing fees