For more information, contact Lori Baden at 203-542-7172 or [email protected]. First Name * Last Name * Address * Address 2 City * State * Zip Code * Email * Phone Number * Tickets & Tables Individual Tickets 01 ticket ($180)2 tickets ($360)3 tickets ($540)4 tickets ($720)5 tickets ($900)6 tickets ($1080) Patron Ticket (Priority Seating) 01 Patron Ticket ($500)2 Patron Tickets ($1,000)3 Patron Tickets ($1,500)4 Patron Tickets ($2,000)5 Patron Tickets ($2,500)6 Patron Tickets ($3,000) Consider Buying a Table! Table Reserved seating for 10 1/2 Page (Supporter) Journal Ad* Table 0$2,500 Gold Sponsor Table Priority seating for 10 Premium Full Page (Patron) Journal Ad* Gold Table 0$5,000 Platinum Sponsor Table Premier seating for 12 Distinguished Full Page (Benefactor) Journal Ad* Platinum Table 0$10,000 *If you already bought a Journal ad at the early bird rate, you will be credited that amount towards your table. Your Journal Ad Text for your Half Page Ad (Leave blank if you need more time) Your Journal Ad Text for your Premium Full Page Ad (Leave blank if you need more time) Your Journal Ad Text for your Dsitinguished Full Page Ad (Leave blank if you need more time) I would like to purchase Luxury Raffle Tickets: - None -1 Ticket ($100)2 Tickets ($200)3 Tickets ($300)4 Tickets ($400)5 Tickets ($500)6 Tickets ($600)7Tickets ($700)8 Tickets ($800)9 Tickets ($900)10 Tickets ($1000) I would like to purchase a Journal Ad (or an Additional Ad) * Yes No I would like to make a donation of: $ CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.