Campaign Headquarters Fundraiser

Event Date: Thursday, January 28, 2016

Time: 5:30 PM

Event Location: LauderAle

Address:   3305 SE 14th Ave Ft. Lauderdale, FL 33316

Contact Information
Employer Information

This information is required by law.

If you are self-employed, please list the name of the entity that is on your paycheck. Please list your line of work. "Business Person" is not acceptable, please enter the type of business instead.

We respectfully request that Partners of Partnerships and Members of LLC's contribute individually, instead of through their respective business entity.

Ticket & Guest Information
Ticket Level Pricing Set Default Value
Admission $25.00
Co-Host $100.00
Host $250.00
To make an additional contribution please enter amount here
TOTAL: $0 QTY: $0
Guest Names Ticket Level

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Payment Information
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