Please complete the registration form below: Contact Info Company: Name: Phone: Email: Tickets How many tickets for dinner? x $50 Dinner names and requests: Sponsorship and Donations Table Sponsor - Name Sponsorship amount ($100 minimum) $ I Would like to make a donation. Donation amount $ Donate a silent auction item: No silent auction itemPlease pick upI will deliver to AJPH (113 Gava Pl, Nanaimo) Total Amount owing: $ How will you be paying? Paypal / CreditcardChequeInterac E-Transfer Please review your information before clicking the submit button below. Once clicked, your registration information will be sent and you will proceed to payment options.
