Silver & Gold Fundraiser Event Registration

Friday, December 6th from 5:30 - 7:30pm | Please fill out this form and click submit.

Your Information

Name

*

Email

*

This address will receive a confirmation email

Phone

*

Ticket Information

Select Your Tickets

1 Ticket ($25) 2 Tickets ($50) 3 Tickets ($75) 4 Tickets ($100) 5 Tickets ($125) 6 Tickets ($150)

Amount

Is this an events regret donation?

Please select all that apply.

No Yes

Are you, and your guests (if applicable), ages 21 and older?

*

Please select one option.

Yes No

Please let us know the full names of those who will be in attendance.

Additional Information

Would you like to join a tour of CITY MISSION's program space?

Please select all that apply.

Yes Please! No Thanks!

Any additional comments?

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Friday, December 6th from 5:30 - 7:30pm

Please fill out this form and click submit.

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