First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

How many tickets are needed?*

Payment is available via Credit/Debit card, Venmo or PayPal. Once we receive notification of your payment, you will receive an email from us confirming your purchase. Your ticket(s) can be picked up at the registration table on the evening of the event. Tickets are $45.00 each. Your payment amount is?*

Is each person using a ticket 21 years of age or over?

The next step is to pay for your tickets. Your order will not be completed until payment is made. How will you be making payment?*
Choose one: Bayside Animal Hospital, White Stone Check (to be mailed to PO Box 257, Kilmarnock, VA 22482 Credit/debit card Directly to a GRI volunteer FNCAS Thrift Store, Burgess Livi's Market, Irvington Venmo WOWD, Kilmarnock