Registration Details
Please print and send

Gala Celebration - November 4, Saturday

Contact: _____________________________________

Company:____________________________________

Address:_____________________________________

_____________________________________________

Phone #: _____________________________________

Email: _______________________________________

Please indicate how you would like to support NHCC:

  □  Gold Sponsor………………………………….$500

  □  Silver Sponsor…………………………………$250

  □  Bronze Sponsor……………………………..$125

  □  Program Ad—Full Page…………………$100

  □  Program Ad—Half Page ……………..  $50

  □  ___ Individual Tickets……………………...$45

  □  I am unable to attend, but still wish to support

  the mission and work of the NHCC in Washington City

  with a donation of ………………………..        $______

Please charge $ _____________ to my

Visa                                Mastercard                                AMEX

Card#___________________________________

Exp. Date: ________________CSC#:_________

Please print name as it appears on the card:

_________________________________________

Signature:_________________________________

Check enclosed made payable to

  “New Hope City Center” ………$______

(Please complete and return with payment to:

New Hope City Center
P.O.Box 4325
Washington, PA 15301

or email to tbellhy@gmail.com