Register for the California Aquatic Therapy and Wellness Center annual awards dinner

First Name:
Last Name:
Title:
Business Name:
Telephone:
Email:
Address:
City:
State(Region):
Zip:

Please indicate the number of tickets or sponsorships you would like to reserve:

(format: 5 for 5 tickets or 5 sponsorships)

Lifesaver Sponser ($1500.00):
10 tickets, 1 bottle of wine, website and newsletter listing, Event signage

Life Preserver Sponser ($1200.00):
8 tickets, 1 bottle of wine, website and newsletter listing, Event signage

Water wings Sponser ($1000.00):
6 tickets, 1 bottle of wine, website and newsletter listing, Event signage

Wine Tasting & International Buffet Dinner ($75.00):


Additional Donation Amount (format: 50 for $50.00):

Paypal