"*" indicates required fields Your InformationName First Last Email* PhoneBilling Address (Must Match Credit Card Billing Address) Street Address / PO Box Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Sponsorship OpportunitiesRock $5,000 Rock $5,000 Website, Social Media, Recognition at the Event, Logo on Bingo card, and 2 ticketsMoTown $3,000 MoTown $3,000 Website, Social Media, Recognition at the Event and 2 ticketsDisco $1,200 Disco $1,200 Website, Social Media, Recognition at the EventPOP $600 POP $600 Website and Social MediaCountry $300 Country $300 WebsiteCountry $300 Price: POP $600 Price: Disco $1,200 Price: MoTown $3,000 Price: Rock $5000 Price: Reserved TablesReserved tables for Groups of six or moreTen Guests Ten Guests - $1,250.00 Eight Guests Eight Guests - $1,000.00 Six Guests Six Guests - $750.00 Ten Guests Price: Eight Guests Price: Six Guests Price: Individual Tickets (Open Seating)Tickets ($125 Per Person) Price: Number of personsList the names attending (one name per line)Add-On Donation (Optional) Credit Card Fee RequestWe are charged about 3% fee for all credit card payments. If you would like to add 3% to your total, we would appreciate it. This request is totally optional. Thanks for your understanding and support of Soroptimist International of Whittier. Yes - I would like to pay the credit card fee. Credit Card Fee $0.00 Total and Your Credit Card InfoCredit CardCard Details Cardholder Name Total CommentsThis field is for validation purposes and should be left unchanged. 98122
