Annual DSA Reach for the Stars Gala

To register simply fill out the following form
Click submit to pay online
Or
Click Print form and mail check payable to DSA
(DSA - 9245 Sky park Ct. Suite 130, San Diego, CA 92123)

Number Attending : Qty Cost

DSA Member Adult (13 yrs. plus) - $110.00

DSA Dues $25.00

Honored Guests:
Individuals with Down Syndrome (13 yrs. plus) $80.00

Non-Member Adult (13 yrs. plus) $125.00

Gold Star Table of 10
* includes preferred seating, table signage and program acknowledgement $1500.00

Total $.00

Gold Star Preferred Seating Guest List:

Meal Choice

Number of meals

Beef :

Fish :

Vegetarian :

Special Diet

Comments:

Reservation Information:

First Name: (As it appears on credit card)

Last Name: (As it appears on credit card)

Guests (Enter Full Names)

Address:

City:

State:

Zip:

Phone Number:

Email:

Payment Information : (Be sure to use your billing Name, address & phone above)

Credit Card Number

Credit Card Code (This is 3 or 4 letter code shown on your credit card)

Expiration Month

Expiration Year

Photo Disclaimer

As part of my reservation to this event, I hereby grant permission to the Down Syndrome Association of San Diego (DSA) or Exceptional Family Resource Center (EFRC) to use my photograph now or in the future on its website or in other DSA/EFRC publications without further consideration, and I acknowledge DSA's and EFRC's right to crop or treat the photograph at its discretion. I also understand that once my image is posted on the DSA or EFRC website, the image can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless from any claims DSA or EFRC.