W4953 Hwy H, Fredonia, WI 53021
(262) 692-9021
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2017 Spirit of Freedom Gala Registration

Name(s): 

Address: 

     

  



Ticket Selection:

Number of Individual tickets @ $85 each:

Corporate Table for 8 people @ $900 each: 

Sorry, I am unable to attend.  However, I would like to make a tax-deductible gift to help the patients of Pine View.

Total Amount:     Payment method:
 
Please note that payment can be made with PayPal or by sending a check to Pine View (address above).  You will be given the option to pay with PayPal once you click on the Submit Registration button. 

Please make a note of your total before proceeding.
  Your total amount will not carry over to the PayPal screen.