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BCSN and Mosaic Family Zone Presents...

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We are pleased to support the October 28th Celebrity Dinner as indicated below *	Quantity
$5,000 - Gold Sponsor
$3,000 - Touchdown Sponsor
$1,750 - Field Goal Sponsor
$250 - Individual Ticket
$25 - x 12 months

PAYMENT INFORMATION CAN BE ENTERED AT THE BOTTOM OF THIS FORM

Contact Information

Name *

First Name

Last Name

Sponsor Name (If different from primary contact)

Email *

Verify Email *

Phone *

Guests can be recorded below at time of registration or emailed to kat.amato@gmail.com by October 18th

Please email with dietary restrictions.
The Cocktail Hour will be operated as a cash bar.

Please list your guests names and emails below

Payment Information

Your payment is due at time of reservation

Online payment can be entered below.

If you are setting up recurring payments, please select the "monthly" option on the form.

To make a general donation to Mosaic Family Zone use this link: https://buy.stripe.com/6oE5nsbofd1G7raeUU

Checks may be drafted to : Mosaic Ministries

Mail to : 860 Orchard St,
Toledo, Ohio 43609

Attn. Celebrity Dinner

Please email Kat.amato@gmail.com with questions about reservations or dietary preferences.

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