CITY OF HOPEWELL DEPARTMENT OF HEALTHY FAMILIES 2ND ANNUAL BLUE GALA
FUNDRAISER AND SILENT AUCTION

ATTENDEE INFORMATION:
Payment Date: 05/01/24
* Attendee Name(s):

Enter the first and last names of attendees separated by a comma.

TICKET INFORMATION:
$77.21 (Includes 2.95% processing fee): Enter the number of tickets you wish to purchase.
$500.00 Gold Sponsorship Package: Enter the number of sponsorships you wish to purchase.
$800.00 Platinum Sponsorship Package: Enter the number of sponsorships you wish to purchase.
$5.00 Raffle Tickets: Enter the number of raffle tickets you wish to purchase.
Total Charge:
CREDIT CARD INFORMATION:
* Card Type:

* Card Number:
*Card Expiration Date: MMYY
* Card ID (CVV2/CID) Number:
[ What is the Card ID ?]
* Name on Card:  
* Card Billing Address:
* Card Billing Zipcode:  
* Email Address:
   


Contact Us

Department of Healthy Families
300 N. Main Street
Hopewell, VA 23860
Phone: 804-352-4018 ext. 645
HealthyFamilies@hopewellva.gov