Registration FormPlease fill out the form below to register for the 2018 LFSA Gala. First Name: Last Name: Company: Address: City: State: -- AL AK AS AZ AR AF AA AC AE AM AP CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Zip: Home Phone: E-mail: Select Number of Seats: -- Single $175.00 USD Table for 2 $350.00 USD Table for 4 $700.00 USD Table for 6 $1050.00 USD Table for 8 $1400.00 USD - Sponsorship Levels - Inferno $10,000 USD Blaze $7,500 USD Fireball $5,000 USD 5 Alarm $2,000 USD 4 Alarm $1,500 USD 3 Alarm $1,000 USD 2 Alarm $500 USD Enter the name(s) of your guests: All donations are used to support the Southern Arizona Lupus Community You are being redirected to the PayPal website to complete your payment. Your registration is not complete until your payment is successfully processed.
You are being redirected to the PayPal website to complete your payment. Your registration is not complete until your payment is successfully processed.