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CPHI Programs - Donate to Help the Homeless

Community Partnership for Homeless Next Generation Council

Invites you to break dance, rock out and walk like an Egyptian at:

FLASHDANCE
THE AFTER PARTY

Get into the groove and enjoy complimentary desserts and open bar.

Friday, November 3, 2006
10:00 PM – 1:00 AM
JW Marriot
1109 Brickell Ave, Miami, FL

Tickets are $50 per person and $60 at the door

Please provide the following information:
 

Party Sign-up Form

 * indicates required fields
Business Name: (If none, leave blank)
First Name:  * (as it appears on your credit card)
Last Name: * (as it appears on your credit card)
Street Address:  *
City:  *
State:  *
Zip Code: *
Country:  *
Phone Number:  *
Fax Number:  
Email Address:  *
Card Type  *

Credit Card Number:  *
Expiration Date: /  *
Donation Amount:
 * Please put numbers only (no $ sign) 
 
 

   



Customer credit cards will be billed as CPHI.
  
 

    

 

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