Registration for 2019 Pharmacy Gala on Mar. 30, 2019  Ridgemont CC

Gala Script

Please RSVP by Mar. 17, 2019.

For gala table registration, see HERE.

For gala sponsorship options, see HERE.


Each attendee may register a guest if desired.

         
Patron - $85 per personStudent - $50 per personHosp. Pharm. Resident - $60
Note that above early bird prices will increase after Mar. 17, 2019.
 
 Attendee First Name     Last Name   
 Street Addr    City      State Zip
 Phone    (123-456-7890)       E-mail   
If payer name on credit card will be different from attendee, please fill in below.
 Payer 1st Name  Last Name   
 Please select one from the menu choices below.
Chicken, Prosciutto Gorgonzola Cordon BleuBacon Wrapped Striploin
Gremolata crusted Sea BassVegetarian Dish
 
Guest Name (If applicable - Fee will be adjusted.)
 Please select one from the menu choices below (if applicable).
Chicken, Prosciutto Gorgonzola Cordon BleuBacon Wrapped Striploin
Gremolata crusted Sea BassVegetarian Dish
 
If you would like to sit with others, enter up to 3 names below. We may not be able to accommodate all requests.
 
If you would like to be a "Friend of Pharmacy," please check the box and select the quantity below.
Friend of Pharmacy   x Quantity at $50 each (names listed in program)
Friend Comments (Optional)
            (Please separate each individual Friend & Comment with a semicolon.)
     Examples of "Friends of Pharmacy" messages could be: Congratulate honoree or Recognize a colleague or mentor.
Additional Friend sponsorship questions or comments may be submitted to Chip at psrochester@ymail.com
 
      Credit card payments will be accepted on PayPal after continuing.
 
 

(Please pay online in advance.)



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