Annual Event Registration

How many tickets would you like to purchase?

A Time for Hope & Healing Fee – 2022

Total

Ticket 1

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 2

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 3

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 4

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 5

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 6

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 7

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 8

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 9

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Ticket 10

Attendee Name(Required)

First Last

Attendee Email(Required)

Attendee Organization(Required)

Dietary Restrictions

If you have special dietary requests, please list them here or contact Sadie Hinkel at shinkel@thekimfoundation.org or 402-891-6911.

Billing Information

Name(Required)

First Last

Email(Required)

Phone Number(Required)

Address(Required)

Street Address City State ZIP Code

Total

Credit Card(Required)

Card Details

Cardholder Name

Annual Event Registration

Ticket 1

Ticket 2

Ticket 3

Ticket 4

Ticket 5

Ticket 6

Ticket 7

Ticket 8

Ticket 9

Ticket 10

Dietary Restrictions

Billing Information

The Kim Foundation

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