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2024 Heart n Soul Gala

* marks the required fields

Here's what to do...

Select the number of tickets below! Click the checkbox next to the Admission tickets and select the number of tickets you need. Everyone will need a virtual ticket to attend! The ticket price includes the evening meal. There will also be a cash-only bar.

Reserve a table! Here's a secret -- buy exactly 8 tickets in one transaction and your party will be assigned to its own table! All other seating is first-come-first-served.

Click here to set the Ticket Quantity *	Quantity
$80 - per Attendee

Congratulations!

Your group of 8 will be assigned to its own table!

Where Do You Want To Sit?

Please indicate your preference for where you want to be seated (closer to the band or farther away from the band). We will try to accommodate your request.

Closer to Band

Farther away from Band

Your Information

Your Name *

First Name

Last Name

Your Email *

Verify Email *

Your Phone

Your Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Your Emergency Contact

Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #2

Name of Attendee #2 *

First Name

Last Name

Email for Attendee #2

Verify Email

Phone for Attendee #2

Address for Attendee #2

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Emergency Contact for Attendee #2

Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #3

Name of Attendee #3 *

First Name

Last Name

Email for Attendee #3

Verify Email

Phone for Attendee #3

Address for Attendee #3

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Emergency Contact for Attendee #3

Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #4

Name of Attendee #4 *

First Name

Last Name

Email for Attendee #4

Verify Email

Phone for Attendee #4

Address for Attendee #4

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Emergency Contact for Attendee #4

Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #5

Name of Attendee #5 *

First Name

Last Name

Email for Attendee #5

Verify Email

Phone for Attendee #5

Address for Attendee #5

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Emergency Contact for Attendee #5

Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #6

Name of Attendee #6 *

First Name

Last Name

Email for Attendee #6

Verify Email

Phone for Attendee #6

Address for Attendee #6

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Emergency Contact for Attendee #6

Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #7

Name of Attendee #7 *

First Name

Last Name

Email for Attendee #7

Verify Email

Phone for Attendee #7

Address for Attendee #7

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Emergency Contact for Attendee #7

Enter the name(s) and phone number(s) of your emergency contacts above.

Attendee #8

Name of Attendee #8 *

First Name

Last Name

Email for Attendee #8

Verify Email

Phone for Attendee #8

Address for Attendee #8

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Emergency Contact for Attendee #8

Enter the name(s) and phone number(s) of your emergency contacts above.

Emergency Contacts

We’d like to have an emergency contact on file for you in case of an emergency at an event. If you have previously given us emergency contact information, you do not need to give it again unless you want to update it.

I'd like to enter Emergency Contact information.

Email List Policy

Each person for whom an email address is provided as part of an event registration is automatically placed on our email list for weekly updates about upcoming activities and other occassional announcements. The recipient of any of these emails may click the unsubscibe link at any point in time to be taken off the list and will not be added again with future registrations.

Waiver of Liability

We require that all participants in Poolesville Seniors activities agree to our Waiver of Liability policy (click here to read it).

Click to Accept Waiver of Liability Acceptance *

I have read and agree to the Poolesville Seniors Waiver of Liability policy for myself and for the others for which I am registering and will type my name below as a signature to indicate my acceptance.

Signature *

Please type your name as a signature.