HSU Event Registration Name * First Last * Last Address Address Address Line 1 Address Line 1 Address Line 2 Address Line 2 City City State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Zip Code Home Phone Work Phone Email * How did you hear about this event? Friend or colleague Radio / TV Social Media OtherOther Company Order Tickets Online HSU 2020 Gala Event ($10) Quantity Can you help us cover our expenses? Checkboxes Yes, I'd like to cover the PayPal expenses related to my purchase These are the PayPal Fees related to your purchase (2.9% + .30). To add them, please include in the field below: Add PayPal Fees here Total to be Charged Submit Δ
