Scholarship and Awards Banquet RSVP

RSVP by November 29th!

Below is your online RSVP for the Scholarship and Awards Banquet. Please complete the form below and click submit. Additional guests may attend for $25 per person.

Students, you and a guest may attend at no charge, and you may have up to two additional guests join you, for a total of four in your party. Payment for additional guests must be made at the time of RSVP form submission.

Schedule
Date | Friday, Dec. 6, 2019
Social | 5:30 p.m.
Dinner | 6:00 p.m.

Please email foundation@cleveland.edu if you have questions. We hope you enjoy the evening!

1 Your Information

2 Guest Information

3 Payment Information

Please indicate if you are a*
- Student
- Scholarship Donor
- CUKC Faculty/Staff or Board Member
Please indicate if you are*
- Attending the Banquet
- Not Attending the Banquet
You have indicated that you are not attending the banquet. Please note that students cannot receive a scholarship unless they are present at the event. If you are unable to attend, please complete the rest of the form and click submit.
Full Name*
First Last
Email Address*
Enter Email Confirm Email
Phone Number*
Your total Number of guests (excluding you)*
Total Amount Due
$0.00

Guest(s) Information*
Please include the name of each guest that will be attending the banquet with you. We also ask that you indicate whether any are chiropractors, or if they are Cleveland alums.
First Name Last Name Chiropractor? (Y/N) Alum? (Y/N)
Total
$0.00
NEXT STEP:

Press "SUBMIT" to go to the payment page. Your registration is not complete until you have paid your amount due by credit card. You will receive a separate payment confirmation. If you do not receive a payment confirmation, contact heather.sulzen@cleveland.edu to complete the registration.

Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

First Name	Last Name	Chiropractor? (Y/N)	Alum? (Y/N)

Scholarship and Awards Banquet RSVP

RSVP by November 29th!

NEXT STEP:

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