The Village for Families & Children · 2021 Girl Within Registration

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Name

First Name

Last Name

Verify Email

Cell phone

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Were you invited to attend by an individual or organization?

Yes

Group or Organization/Employer

Ticket

Regular ticket price: $150 (patron); $100 (individual)

2021 ticket price: FREE

I would like to make a donation in lieu of the regular ticket price.

Donation

$150

$100

$50

Optional guest activity

At Girl Within, some of the most memorable moments are when our guests connect through shared experiences. If you feel comfortable doing so, please complete the following two questions that will then be anonymously shared as part of the guest activity during our event this year.

In one or two words, what is a significant life challenge you’ve faced that tested your mental/emotional health?

Your answer will be anonymous, aggregated and incorporated into the program.

In one or two words, what helped you through that time?

Your answer will be anonymous, aggregated and incorporated into the program.

Add 3% to my total amount to help cover the payment processing fees