Norooz Clinic Foundation 5th-Year Masquerade Gala

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Registration form for attendees.

Please indicate whether you would like to buy individual tickets or a table.

Individual ticket: $90
Table: $750
Non-Profit Table: $500

When: September 30th, 2017 from 6:00 PM to 10:00 PM
Where: Ocean Institute, Dana Point, CA
What: NCF is celebrating 5 years of providing direct affordable mental health services and advocacy to the community.
Attire: Formal Evening Attire with optional mask (some masks will be provided at event)
Parking: Free
Dinner: Full 3-course meal with optional alcoholic beverages
Entertainment: Lion dance, keyboard player, keynote speakers, silent auctions, others.

www.noroozclinic.com
www.facebook.com/NoroozClinicF

For the full program book with in-depth description of key note speakers, performers, venue, menu, and more; please click here: http://bit.ly/2xj3WoA

To sponsor for our event, please contact Mariann Ivan at 949.346.2406 or mivan@noroozclinic.com and download our sponsorship our packet here: http://bit.ly/2wPlx68

Name of Attendee(s): *

If buying a table, Name of Company (please also indicate if you are a non-profit).

Address: *

Phone Number: *

Email: *

Individual Ticket(s) or Table(s) ? *

Individual Ticket(s)

Table(s)

# of Tickets: *

# of Tables:

Do you require a vegetarian meal? *

Yes

How would you like to pay? (Please do not send cash, choose one of the payments below only): *

Check (please mail it to Norooz Clinic Foundation: 202 Fashion Lane, Suite 219, Tustin, CA 92780)

Credit Card/PayPal: http://bit.ly/2wELeDh (Your ticket purchase counts as a donation. We will provide you with a receipt for tax exemption purposes at the event.)

If you cannot attend but would like to donate, please go to the link below:

http://noroozclinic.com/WP/index.php/home/please-donate/

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Agreement:

I certify that all of the information above is correct and I understand that after submitting this form, I will pay the Norooz Clinic Foundation, a non-profit 501c(3) organization, for the amount of ticket(s) that I have stated by using one of the methods mentioned above. I, also, understand that if I fail to pay by September 25th, 2017, I will forfeit my ticket(s) and will not be admitted to the Gala on September 30th, 2017.

Please sign name & date: *

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