Event Registration

You may use this page to be an event sponsor or to purchase your attendance tickets by making your secure online payment using a credit card (VISA, MasterCard, Discover or American Express). As an alternative, you can also print out this page, fill in the information and mail it with your check to our administrative home office, at:

Preeclampsia Foundation

6767 N. Wickham Road, Suite 400

Melbourne, FL 32940

Tax ID Number: 91-2073087

Our Pledge to Accountability & Stewardship

By completing this registration form, you hereby grant the organization specific permission to reproduce, publish, circulate, copyright, or otherwise use any and all photographs and/ or videotape of you and/ or your family taken at the 2014 Saving Grace gala, for use by the organization.

How many people are you registering?

(including yourself)
Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Continue".

Different Ways to Participate

I want to PURCHASE "VIP" TICKETS VIP (prices to be determined) tickets	I want to PURCHASE "Regular" TICKETS Regular (prices to be determined) tickets
Names of All Guests (Separate guest names with commas)	I want to be a SPONSOR Sharing Hope - $ 25,000.00 Sharing Gratitude - $ 10,000.00 Inspiring Community - $ 5,000.00 Saving Lives - $ 2,500.00 Not at this time
Sponsorship - Other Amount
Total Contribution :

Email Address *

Donor Information

* Indicates a Required Field

Title

First Name *

Last Name *

Suffix

Street Address *

City *

Country *

State/Province *

Zip/Postal Code *

Phone

Organization Name

Contact Person

Customer address is the same as the billing address.

Credit Card Information

* Indicates a Required Field

Card Type *

Card Number *

Enter numbers only, no spaces or dashes.

Security Code *

Usually the last 3-4 digits in the signature area on the back of the card.

Expiration Date *

Billing Name and Address

* Indicates a Required Field

Enter the name as shown on your credit or debit card, and the billing address for this card.

First Name *

Last Name *

Street Address *

City *

Country *

State/Province *

Zip/Postal Code *

We are extremely grateful for the support of our 2014 Saving Grace sponsors. The Preeclampsia Foundation does not endorse any opinions, beliefs, or findings of any sponsor at any time.

The Preeclampsia Foundation (PF) is a 501(c)(3) non-profit organization, Tax ID# 91-2073087.

For more information about the Saving Grace gala, please email Saving Grace co-chairs Jaime Nolan or Kristy Heer.

For more information about the Preeclampsia Foundation, please visit our website.