Celebrate Life Dinner Registration (Pay by Check)
If you are trying to pay by card DO NOT fill this form out. Please go to http://rtlindy.org/upcoming-events/online-registration/

Donation Levels:
Defender of Life Donor – $2,500 or more (includes reserved table, 10 dinners, and 4 invitations to speaker reception)
Diamond Donor – $2,000 or more (includes 4 dinners and 4 invitations to speaker reception)
Platinum Donor – $1,250 or more (includes 2 dinners and 2 invitations to speaker reception)
Gold Donor – $500 or more (Dinner tickets not included)
Silver Donor – $250 or more (Dinner tickets not included)
Bronze Donor – $100 or more (Dinner tickets not included)

Dinner Only – $75 per person Student Table Sponsor – $425

Full Name *
Your answer
Email *
Your answer
Organization
Your answer
Street Address *
Your answer
City, State, Zip *
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Phone Number
Your answer
Donation level *
See above for details. Each level is that amount or more. We thank you for your generosity!
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