CITY OF HOPEWELL HEALTHY FAMILIES
2023 BLUE GALA PAYMENT FORM

ATTENDEE INFORMATION:
Payment Date: 06/10/23
* Attendee Name(s):

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

TICKET INFORMATION:
$51.50 (Includes 2.95% processing fee): Enter the number of tickets you wish to purchase.
$500.00 Corporate Table Sponsorship: Enter the number of corporate tables you wish to sponsor.
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

Hopewell-Prince George Healthy Families
300 N. Main Street
Hopewell, VA 23860
Phone: 804-352-4018 ext. 645