register forA Night for AdvocacySeptember 20th, 2025 | Salem Convention Center Attendee InformationIf you can’t pay with a credit or debit card, please call the office at (503) 463-8563.Registration Quantity Price: $100.00 Quantity Full Name* First Last Address*Please enter the address associated with your credit card. 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 Phone*Email* My Menu Selection* Steak (GF) Salmon (GF) Tofu (GF/Vegan)Garden salads and dessert will be provided at your table.Does anyone in your party (including you) have a food allergy?* Yes, I have a food allergy Yes, someone in my party has a food allergy No one has a food allergyWhat is the food allergy?*How many guests are you bringing?*Please enter a number greater than or equal to 0.Guest Information and Menu SelectionsGuests Info and menu selections Guest Name Menu Selection Email Phone AddressActions EditDelete There are no guests. Add guest Maximum number of guests reached. For the purpose of meals and seats, the guest list should include all children above 3 years of ageTable RequestPlease list anyone you'd like to be seated by or with. We will accommodate to the best of our abilities.CommentsAdditional accommodations or food allergies we can be aware ofPayment InformationPurchase Total $0.00 Credit Card*American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.
