Leaders Luncheon 2022 Registration Event TicketsLuncheon with Chicken Entree Price: $65.00 Quantity: Individual Seat with choice of Air Line ChickenLuncheon with Shrimp Entree Price: $65.00 Quantity: Individual Seat with choice of Shrimp ScampiLuncheon with Vegetarian Entree Price: $65.00 Quantity: Individual Seat with choice of Fettuccini AlfredoiTable Sponsor Price: $550.00 Quantity: Includes Table Sponsor recognition at Event. 8 Guests of your choice to sit at your reserved table. Enter below the names and choice of entree for each.Total $0.00 Name* First Last Email* Company / Organization PhoneNames You Are Registering with Choice of Chicken/Shrimp/Vegetarian Entree (One Name Per Line)Billing Address (Must match billing address on credit card.)* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name
