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Dosher Memorial Hospital

2018 Foundation Gala Reservations & Sponsorship

The Dosher Memorial Hospital Foundation is holding a black-tie optional Gala Fundraiser on...

Friday, April 27, 2018, 6-11 p.m., at St. James Community Center, Southport, N.C.

This form allows you to make and pay for your reservations ($125 per person) and/or purchase a sponsorship for this year’s Gala. Please submit this form along with your credit card information.

Your name(s) will appear in the program and on the attendance list at the registration table.

Space is limited, so purchase your tickets early.

If you have any questions, please call Foundation President Lynda Stanley, at 910-457-3850 or email lyndastanley@dosher.org.

Thank you for your support!

* Entertainment by Andrew Thielen Big Band
* Tickets: $125 per attendee
Please RSVP by April 16, 2018.

Fill in all fields below and submit information.

* Required field.
Attendee information:
* Name:
* Address:
* Phone:
* Email:
  Unable to attend but would like to make a donation:
Tickets:
  Number of tickets:
  Total amount of tickets @ $125.00 =
  Attendee names:
  Please list any table requests:
Sponsorship Information
  In addition, I would like to be a sponsor:
Credit Card Information
* Credit card type:
Please select the type of credit card you are using.
Visa     MasterCard     Discover     American Express    
* Name on card:
Enter the name on your credit card.
* Billing address:
Enter the billing address of the credit cardholder.
* Credit Card Number:
Input the credit card number just as it appears on the card.
* Credit Card Expiration Date:
Please enter the expiration date of the credit card (for example 08/09/2017).
* CV code:
Please enter the CV code found on your credit card.
* Transaction Amount:
Please enter the total amount to be charged to your credit card (for example $200.00).