Individual Registration

Please enter information in the form below to register for our 2026 Annual Civic Awards Luncheon event.

Ticket Type	Price	Available place
Plain Grilled Chicken	$30.00	Unlimited
Cheddar Broccoli Quiche	$30.00	Unlimited
Vegetable Napoleon	$30.00	Unlimited

Email *

First Name *

Last Name *

Organization

Address *

Address 2

City *

Zip *

State

Phone

Comment

Amount

Payment Method *

Paypal Offline Payment

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

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