Bacchus Ball Registration: Benefiting the Diabetes Foundation of Mississippi

Saturday, February 4, 2017 Jackson Country Club
6:30 PM - 11:30 PM


Secure Payment Form
If you have any questions or this form doesn't allow you to choose the options you wish, don't hesitate to call the Diabetes Foundation of Mississippi at 601-957-7878.
Guest List
(Individuals Please list using Guest 1, 2, etc.)
Sponsorships have 2, 4, 6 or 10 Seated Guests)












Registration Options
  • Sponsorships including Krewe Couples - Will appear in Program

Unseated Individuals
  • ($125.00 per unseated)

 
Order Summary:
Order Date: 06/23/17
Total Amount: 250.00
           
Credit Card Information:
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Shipping Information:
Same as Billing:
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