Annual Celebration Registration

Celebrate With Us

Join us for Region IV’s Annual Celebration, an evening honoring the people
and partnerships that make this work possible. Reserve your ticket or table below.

Registration Form

Your Information

Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Business/Organization

Ticket Selection

Ticket Selection (Pricing)(Required)

Individual Ticket ($50 each ticket)

Table of 8 ($350 each table = 8 tickets)

Donate a Ticket ($50 each ticket)

Quantity

Please enter a number greater than or equal to 1.

Total

Payment

Payment Method(Required)

Purchase Online (credit card / PayPal)

Mail a Check

Please mail your check to:
Region IV Area Agency on Aging
2900 Lakeview Ave.
St. Joseph, MI 49085

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Attendee Names

Names of Attendees

List up to 8 attendee names (helpful if a table is purchased, or if you are registering on behalf of someone else).

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