To The Ends of the Earth Gala

Please fill out this form and click submit.

Name

*

Email

*

This address will receive a confirmation email

Phone

*

For information on sponsor tiers, please visit To the Ends of the Earth Festival Gala Sponsorship

Payment

1 ticket ($100) 2 Tickets ($200) 3 Tickets (300) 4 Tickets ($400) 5 Tickets ($500) 6 Tickets ($600) 7 Tickets ($700) 8 Tickets ($800) 9 Tickets ($900) 10 Tickets ($1000) Silver Sponsor ($1000) Gold Sponsor ($2000)

Amount

If purchasing multiple tickets or if you choose to be a sponsor, please list the names of attendees:

Are there other attendants you would like to sit with? (Optional field, we will accommodate seating requests as best as we are able)

Which charity would you like the proceeds from your ticket sale/Sponsorship to go to? (If none is selected, it will be shared between all)

Please select one option.

Shared between all Diakonia Retreat Center Farrell Cares The Greek Children's Fund of Florida Pasco Kids First Philoptochos of St. George, our women's philanthropic auxiliary group United Way Pasco County West Pasco Pregnancy Center Good Samaritan Health Clinic of Pasco Grace's Food Pantry

Additional Charity Donation (Optional)

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.

Please Fix the Following

Close