May Gala Registration Name(Required) First Last Mailing Address(Required) Street Address Address Line 2 City State 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 ZIP Code Email(Required) CCF News & Events I Would Like to Receive Information About Upcoming CCF Events and News Tickets or Sponsorship(Required)Single Ticket $225Couples Ticket $425Table of 12 $2,700Table of 10 $2,250Grand Mask Sponsor Sponsorship $7,500Crown Jewel Sponsorship $5,000Velvet Mask Sponsorship $2,500Moonlight Mask Sponsorship $1,500Enchanted Elixir Sponsorship $1,000Add a Mask? ($100) Yes No Name on MaskI would like to be seated with...Signature CocktailCover Fees I would like to cover the fees associated with my ticket purchases so more of my contribution goes directly to Children’s Cancer Fund. Processing Fees Price: $0.00 Total Photo Release I grant permission to the Children’s Cancer Fund to use or authorize others to use any photographs, videos, recordings or any other record of my participation in the Event or related activities for any purpose without payment to me. Payment Method(Required)Credit Card American ExpressDiscoverMasterCardVisaMaestroSupported Credit Cards: American Express, Discover, MasterCard, Visa, Maestro Card Number Expiration Date Security Code Cardholder Name
