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St. Luke Community Hospital

Foundation Dinner Tickets

St. Luke Community Healthcare Foundation
Fundraising Gala Friday September 14, 2018.

6:00pm cocktails, 7:00pm dinner followed by the live auction. Tickets are $75.00 each.

Please complete the form by entering your credit card information, including the expiration date and 3 digit security code on the back of your card. Or you are welcome to call 528-5324 or email jbischof@stlukehealthcare.org directly to reserve your tickets.
* Name
Full Name
  Email Address
Email
* Contact Information
Phone Number
* Number of tickets
Tickets are $75 each
  Total dollar amount for tickets $
* Add a gold star
Gold stars are $100 each. If your name is drawn, it will award you the choice of any auction item, live or silent before bidding is completed.
$
* Total
Total amount to be charged to credit card
$
 
Would you like a copy of your receipt?
 
* Cardholder First Name
The first name of the account holder as it appears on the credit card.
* Cardholder Last Name
The last name of the account holder as it appears on the credit card.
* Amount of Payment
Format: 45.67 (Include decimal and cents. Do not use a dollar sign.)
$
* Card Number
* Expiration Date
* Card Code Verification Number
The three digit number on the back of your card. (Four digit code on the front of American Express.)
* Billing Postal or Street Address
* Billing City
* Billing State
* Billing Zip Code
5 digit zip code
* Contact Phone Number
Please provide a phone number where we may reach you regarding this payment