Company Name (if applicable)
Your Email (required)
Telephone Number (required)
Number of Tickets
Sponsorship or Registration Level
---PRESENTING Sponsors - $5,000CARE Sponsors - $2,500SUPPORT Sponsors - $1,000HOPE Sponsors - $500Friend (please provide details of donation below)
If applicable, please give a description of the item you wish to donate for prizes/silent auction/raffle draw (include estimated value).
Method of Payment
---Cheque payable to Precious Minds Support ServicesPayPaleTransfer to firstname.lastname@example.orgMastercardVisa
Credit Card Information:
Name on Card:
Please advise which name the tax receipt should be issued to, and email address, if different from the contact person above
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