13TH ANNUAL CHPAA GALAPlease enable JavaScript in your browser to complete this form.RSVP by October 20, 2023Name / Organization / Company *Email *Phone *Address *Address Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNumber of Attendees1 Person – $ 95.002 Persons – $ 190.003 Persons – $ 285.004 Persons – $ 380.005 Persons – $ 475.006 Persons – $ 570.007 Persons – $ 665.008 Persons – $ 760.009 Persons – $ 855.00Multiple boxes can be selected to add up to your number of attendees.Number of Tables1 Table – $ 950.002 Tables – $ 1,900.003 Tables – $ 2,850.004 Tables – $ 3,800.005 Tables – $ 4,750.00Multiple boxes can be selected to add up to your number of tables. Note: 10 people per table. NOTE: You are selecting both the Number of Attendees and the Number of Tables. Make sure that is your intention. Please review the Total cost. Total *$ 0.00How would you like to pay? *Credit CardZelle to [email protected]CheckCashPlease be sure to Zelle your payment by 10/20/2023 or your reservation will be cancelled. Any questions, please contact Suki Thong (email [email protected], text 562-260-1757).Please make check payable to “CHPAA” and send to: 930 Pine Avenue Long Beach, CA 90813 For other arrangements, please contact Suki Thong (email [email protected], text 562-260-1757) by 10/20/2023 or your reservation will be cancelled.For cash payment, please contact Suki Thong (email [email protected], text 562-260-1757) by 10/20/2023 or your reservation will be cancelled.Credit Card *CardName on CardCommentsIf you prefer to sit with other guests, please specify their names here. We will try our best to accommodate, but we definitely cannot guarantee.Signature *Clear SignatureSubmit
