A Night of Hope Form

A Night of Hope
Saturday, September 30, 2023
6 to 9pm
Wild Sun Winery and Brewery

Donor Information

Last Name*

First Name*

Donor Address

Street Address*

Street Address Line 2

City*

State/Region*

Enter Region

Zip Code*

Donor Contact Info

Home Phone

Enter International

Home Email*

Payment Options

Payment Method

Credit Card Information

Card information is sent directly to processor over encrypted connection and not stored in database.

Accepted Cards

Is Billing Address Different?

Credit Card Number*

Credit Card Expiration Month*

Credit Card Expiration Year*

Credit Card Security Code (CVV)*

Guests

Please list all guests in your party (if purchasing individual tickets) or at your table (if you are an event sponsor). You're not required to enter all your guests at this time. You can email us at rebekah@nightlight.org to register any remaining guests or make other changes.

Guests

First Name	Last Name	Phone Number	Email
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International
		Enter International

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