Gala Registration - Bithiah's Family Services

First Name *

Last Name *

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal

Email *

Phone *

Quantity

Choose Sponsorship/Ticket Level *

Choose An Option

Additional Donation Amount

Please enter the amount you wish to donate.

Total

Refund Policy: If the event must be canceled or rescheduled due to Covid-19, event fees will be refunded.

Credit Card