2017 RPD Award Dinner Name* First Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* $250 Patron ticket Price: $250.00 Quantity: $125 Individual ticket Price: $125.00 Quantity: Attendee Names*Please enter the names of those who will be attending below.Please select your sponsorship level choiceNo sponsorship$10,000 - Champion Sponsor$5,000 - Advocate Sponsor$2,500 - Leader Sponsor$1,500 - Supporter SponsorI'm a KCFAA member.Check this box to be seated with your fellow members in the "KCFAA Member" section at the event. Not a member? Join today at https://www.kcfaa.org/join/. Yes, I'm a KCFAA member! Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name Total
