MyEventRunner - Event Public Fill

Your Information

First Name:

Last Name:

Full Name of Person Attending (Yourself or Guest):

Email:

Phone:

Address 1:

Address 2:

City:

Zip/Postal Code:

State/Province:

Dinner Choice:

Ticket Sold By: (Name of Cosmo Member):

Dinner Choice-ticket 2:

Dinner Choice-ticket 3:

Dinner Choice-ticket 4:

Dinner Choice-ticket 5:

I consent to the collection, storage, and use of my information by Rockford Cosmopolitan Club as described in this Privacy Policy. I understand that I may receive emails regarding this event and other relevant information, and can opt out at any time. Required

Select Options