Grad Nite Registration ($180)
*
Students Name - First:
*
Last:
Student's Phone - Cell:
Home:
Student's Email:
Address:
City:
Zip:
*
Emergency Contact - Name:
*
Phone:
Emergency Contact - Name:
Phone:
Mothers Email:
Fathers Email:
* required field
Taste of Dana Tickets ($20 ea)
*
Hold for (name):
Phone:
*
Number of Tickets:
* required field
Holiday Ornaments ($10 ea)
*
Hold for (name):
*
Quantity:
Message:
Phone:
Each ornament may include a 25 character message.
* required field
Additional Donation
We are a non-profit organization dedicated to providing a safe, drug and alcohol-free Grad Nite celebration for our
graduating seniors. If you can help with an additional donation, we will put your contribution to good use. Thanks!
Additional Donation: $
We accept Visa, Mastercard, Discover and AMEX
Total
