MAX Heroes Event

Please register with the name that appears on your your Donor ID Card

Name:*

First

Last

E-mail:*

Phone:*

Area Code

Phone Number

$10 per person refundable reservation fee
All-you-can-eat section seating
Vegetarian option available

If you have any questions regarding payment ,
please call 480-675-5460

Please only choose one of the payment options below.

# of Attendees:*

Payment Method:*

Pay Online Via Credit Card

Mail a Check

Sponsor/CLC

PAY VIA CREDIT CARD: Leave blank if using another method

$10 (One Attendee)

$20 (Two Attendees)

Make checks payable to Vitalant
MAIL BY APRIL 2 TO:
Vitalant - MAX Heroes Event
6220 E. Oak Street
Scottsdale, AZ 85257

Please list the names of all event attendees.

Attendee 1*

First

Last

Attendee 2

First

Last

# of Vegatarian or Vegan Meals Needed

Is there anyone (other than your guest) that you'd like to sit with?

Do you have any accessibility concerns? (difficulty with stairs, wheelchair access, etc.)