register for A Night for Advocacy Attendee InformationIf you can’t pay with a credit or debit card, please call the office at (503) 463-8563.Registration Price: $100.00 Quantity: Full Name* First Last Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Please enter the address associated with your credit card.Phone*Email* My Menu Selection* Italian Stuffed Chicken Grilled Salmon (GF) Curried Chickpeas with Lentils (GF/Vegan) Garden salads and dessert will be provided at your table.Guest Information and Menu SelectionsGuests Info and menu selections Guest Name Menu Selection Email Phone Address Actions Edit Delete 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 age Table Request Please 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 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. Join Host Committee
