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Register now / Benefit Gala / Cirque Éloize
Thursday May 9, 2019, Rosita welcomes you in her rose garden!

To register for the benefit gala or to make a donation to Cirque Éloize, please complete this form. We will contact you as soon as possible to confirm your registration, and send you all relevant information.

We look forward to welcoming you to this most passionate evening!

Here is an overview of "Le Jardin de Roses"
ABOUT YOU
Please enter your contact informations
Name of the company or donator *
Your answer
Billing adress *
Your answer
CONTACT PERSON
This person will be contacted to complete your registration, provide your guests list (if needed) and assure payment tracking. We are already looking forward to working with you!
Name *
Your answer
Last name *
Your answer
Email address *
Your answer
Phone number *
Your answer
Other information (if necessary)
Your answer
PURCHASE
Please select item(s).
Ticket(s)
If you have a promotional code, please write-it in the field below.
Your answer
Great donor 2 500$ - including 2 tickets
Table 5 000$ - including 10 tickets
I would like to sponsor the event (no tax receipt available)
I can not attend the event, but I would like to make a donation. Please write the amount in the field below.
Your answer
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