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Online Event Registration
If you prefer, you can mail or call in your registration information.
Thank you for registering for our
Annual Community Connections Dinner Gala!
Step 1:
I WILL be attending this event
Unfortunately, I will not be able to attend, but I do want to make a donation
(Please complete Steps 1 & 3)
First Name
Last Name
Address Line 1
Address Line 2
City
State
AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District Of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
Zip Code
Email Address
Phone
Step 2:
Number of tickets to be purchased at $75 each:
0
1
2
3
4
5
6
7
8
9
10
If purchasing tickets for attendees other than yourself, please list names here:
It’s okay if you don’t know all the names now, just email
Heather Fritts
or call 206-631-8817 when you have the names.
Choose one of the following:
I am the Table captain/host
I am the Table Sponsor (purchasing all 10 seats at my table)
Please seat me at
's table.
I will sit wherever is convenient
Step 3:
Ticket Purchase
(Tickets are $75 each)
Non-Ticket Donation
I want to be a sponsor!
Platinum $7,500
Gold $5,000
Silver $2,500
Bronze $1,000
Choose one of the following:
Donate using your credit card through PayPal
(You do not need a PayPal Account for this option)
Donate through your existing PayPal Account
Donate over the phone (You will be contacted within 3 business days)
Need more information? Email
Heather Fritts
, Development Director, or call 206-631-8817.
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Administrative Offices: 17018 15th Avenue NE, Shoreline, WA 98155 | Bus Lines: 77, 348 | 206-362-7282 V/TDD
© Copyright 2008 Center for Human Services. All rights reserved.