2026 LATINO CHAMBER RECEPTION
Secure Payment Form
CONTACT INFORMATION
COMPANY NAME
FIRST NAME
LAST NAME
EMAIL ADDRESS
STREET
STREET (SECOND LINE)
CITY
STATE
ZIP CODE
PHONE NUMBER
TICKETS - GALA 2026
MEMBERS: $65.00
NON-MEMBERS: $75.00
DAY OF EVENT-IF AVAILABLE: $95.00
VIP TABLE -7 GUESTS: $650 (INCLUDES LIGHT FINGER FOOD AND RESERVED SEATING ONLY)
TOTAL AMOUNT
COMMENTS
CREDIT CARD INFORMATION
NAME AS ON CARD
CARD BILLING ADDRESS
CARD NUMBER
CARD BILLING ZIP
CARD EXPIRATION DATE
CVV2/CID
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