Gala Registration

February 5, 2013

Yes, i will be sharing my voice at the 3rd Annual International ‘i have a voice’ Gala!

Enclosed is my Registration for the 3rd Annual International ‘i have a voice’ Gala in Des Moines! Saturday, February 23, 2013      Marriott Downtown Des Moines                6pm

_____ # of seats at $85.00 per seat ____________ _____ # of tables at $850.00 per table __________ _____ I cannot attend, but I wish to share my voice

_____by sponsoring _____ # of tickets at $85.00 each for individuals with Down syndrome to attend.

_____ with a donation of $__________.

Name(s): _____________________________________________________________Phone # _____________________________

Address: _________________________________________________________________________________________________ Email Address: ____________________________________________________________________________________________ Please charge my: _____ MasterCard _____ Visa _____ American Express _____ Discover

Name on Card: ____________________________________________________________________________________________ Card #: ___________________________________________________Exp. Date: ______________ CVC Code: ______________

Signature: _________________________________________________________________________ Date: _________________ If registering for more than one person please tell us their names: _____________________________________________________ _________________________________________________________________________________________________________

Name of person with Down syndrome whom you are supporting: ______________________________________________________ A receipt and confirmation will be sent to you.  Thank You for your support of GiGi’s Playhouse Des Moines.

Mail Gala Registration to: GiGi’s Playhouse   10430 New York Ave, Suite A   Urbandale, IA 50322 You can Register Online at: www.gigisplayhouse.org/desmoines or Call 515-252-7529

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