Event Tickets
$200 each

Optional Special Gifts
Gifts over-and-above the ticket price will be matched by an anonymous donor up to $10,000 to benefit the
Kate Piper Fund for Palliative Care.

Support at the $1,000+ level (both tickets & gifts) will receive a commemorative engraved crystal in memory of the person named below in the “Recognize the following person” section.

Learn More About the Gala

Employee Form

Questions?

Contact: Jen Layn
802-748-7313
j.layn@nvrh.org

$ Donation Amount:

Personal Info

Title

First Name *

Last Name

Email Address *

Make this an anonymous donation.

Home Phone

Cell phone

Acknowledgment Name

Confirming Special Gifts

I'd like to recognize the following person at the Gala

Yes, please
No, thank you

Dedication Type

in memory of

Honoree Details

First Name *

Last Name *

Credit Card Info

This is a secure SSL encrypted payment.

Billing Details

Country *

Address 1 *

Address 2

City *

State *

Zip / Postal Code *

Donation Total: $200.00

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