Celebration of Service Dinner Ticket Order

Join us for our Celebration of Service Dinner on Thursday, April 16, at the Monona Terrace. The evening will begin at 5:30 p.m. with a reception, silent auction and music, followed by dinner and a program. The program ends at 8:30 p.m. with dessert and more music.

Please fill out the form below to order tickets. This event supports the work of Access Community Health Centers. If you need assistance with your order, please contact us at (608) 443-5544. All transactions conducted on this web site are encrypted using a secure server to protect your privacy.

Contact Information

Name Address Address 2 City State AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip E-mail Phone

Be assured that your contact information is secure and is never sold or shared. We ask for your phone and email information so we can reach you if there is a problem with your gift. We may from time to time need to update a credit card expiration date or clarify the intention of the gift.

Name of Attendees

1. 2. 3. 4. 5. 6. 7. 8. Names of guests receiving vegetarian entrees: Is there anything else that would be helpful for us to know?: Purchase up to 7 individual tickets ($125/ticket): -- select -- 1 2 3 4 5 6 7 Purchase table ($1,000/8 tickets): -- select -- yes

Credit Card Information

Name as on Card Card Number Card Expiration Date (MMYY) Card ID (CVV2/CID) Number

Billing Information

Individual/Organization Name Address Address 2 City State AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip

Total: $0