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Dress for Success Mid-Fairfield County Gala Online Form

 

 

Design for Success (Cocktails, Hors D'Oeuvres, Fashion Show & Auction)

Date:  Friday, November 6, 2009
Time:  6:30pm - 9:00pm
Place:  Darien Sport Shop, 1127 Post Road, Darien, CT

For more information and to order tickets over the phone, call 203-610-8570.

* = required field.  
Donation Amount: *
(US Dollars)    

$50.00   1 ticket:  Fall Gala 
$100.00   2 tickets:  Fall Gala
$150.00   3 tickets:  Fall Gala
$200.00   4 tickets:  Fall Gala
$250.00   5 tickets:  Fall Gala
$300.00   6 tickets:  Fall Gala
$350.00   7 tickets:  Fall Gala
$400.00   8 tickets:  Fall Gala
$450.00   9 tickets:  Fall Gala
$500.00   10 tickets:  Fall Gala

If you would like to purchase 11 or more tickets, please complete another online ticket purchase form or call 203-610-8570 to order tickets over the telephone.

I cannot attend but would like to make a donation.
other $   

For each ticket, you will need to provide the name of the ticket holder:

Ticket Holder #1's Name

Ticket Holder #2's Name
Ticket Holder #3's Name
Ticket Holder #4's Name
Ticket Holder #5's Name
Ticket Holder #6's Name
Ticket Holder #7's Name
Ticket Holder #8's Name
Ticket Holder #9's Name
Ticket Holder #10's Name

Hear About Us How did you hear about Dress for Success Mid-Fairfield County?
Gift Information:
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  anonymous donation 

Please send acknowledgement of this gift to:

(email address or postal address)
First Name: *

Last Name: *
Billing Address1: *
Billing Address2:
City: *
State:
Zip / Postal Code: *
Country: *
Phone/Ext:
Email: *
First Name on Card: *

Last Name on Card: *

Dress for Success Mid-Fairfield County has partnered with Sage Payment Solutions to securely process your online credit card donation. You will enter your payment information on the following secure page.
Dress for Success Mid-Fairfield County is a project of The WorkPlace, Inc.