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First Name
*
Last Name
*
Cell Number
*
Email Address
*
Number of tickets desired
1
2
3
4
5
6
7
8
9
10
1 VIP
2 VIPs
3 VIPs
4 VIPs
Are you a current Chairwoman's Circle or Chairwoman's Pinnacle member?
*
Yes
No
Do you wish to sponsor a table ($2,500-$25,000)?
*
Yes
No