Please fill out a separate form for each participant. Price: $20.00 + $2.00 online processing fee Price Includes dinner and one bingo card. Additional cards can be purchased for $5 at the event. There will also be a “cash only” bar to purchase beverages. There will be two separate drawings for $50 each, as follows: Members will receive one raffle ticket for every new member that submits an application (*between May 1 and Sept. 21) or for bringing a prospective member to this event. New members* and prospective members that turn in an application at this event will receive one raffle ticket. Click here for membership information. Please bring your friends, family, colleagues and bosses. Please bring donations to support the Mercy House in SSF, which houses homeless Veterans!!! Requested items are basic living essentials: For example, bedding for full-size beds, kitchen/bath towels, paper towels, toilet paper, laundry soap, DO, shampoo and condition, cat food, gift cards in small increments (i.e., $5-$10) for Safeway, Target, Walgreens or CVS, and any other basic essentials. Click here for the flyer. Register by September 17, 2021 Price Price: How did you hear about this event?What Professional LSA/LPA Organization do you belong to?(Required)Choose...Alameda County LSABeverly Hills Century City LSAConejo Valley LPAContra Costa County LPADesert Palm LPAFresno County LPAHumboldt County LPALivermore-Amador Valley LPALong Beach LPALos Angeles LSAMarin County LPAMerced County LPAMt. Diablo LPAOrange County LPAPlacer County LPARio Hondo District (LA County) LPARiverside LPASacramento LSASan Diego LSASan Fernando Valley LSASan Francisco LPASan Gabriel Valley LSASan Mateo County LPASanta Clara County LPASanta Cruz County LPASanta Maria LPAStanislaus County LPAStockton-San Joaquin County LPATrinity County LSAMember at Large (MAL)Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Phone(Required)Total Credit CardCard Details Cardholder Name CAPTCHA