HSU Event Registration Name * First Last * Last Address Address Address Line 1 Address Line 1 Address Line 2 Address Line 2 City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming 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
