College of Podiatric Medicine Hall of Fame and Alumni Awards

Registration Information:

DeleteGuest _ID_
Create Gift - Amount Count Count sum Count Sum Trigger Select Ticket Type* Select Ticket Type* 1) Single Ticket - $150 2) Table Ticket - $1200 One ticket to the Hall of Fame and Alumni Awards Ceremony One table at the Hall of Fame and Alumni Awards Ceremony (includes tickets for up to eight people This is for testing the form only Sorry, a ticket you selected is not available in this quantity. Please select a different ticket. First name* Last name* Email address* Mobile phone Would you like to receive a text message reminder prior to the event? Would you like to receive a text message reminder prior to the event? Yes No Birthdate Birthdate Why do we ask for your birthday? We want to make sure you're appropriately credited for this donation / event registration. Your date of birth is one of the data points that we use to make sure this registration matches to your record in our database. Please select your primary Kent State affinity* Please select your primary Kent State affinity* Alumni Faculty/Staff Student Guest Child Under 18 What year did you graduate from Kent State (if applicable ): Dietary Restrictions I am a I am a Member of the Class of 1976 (celebrating 50th anniversary) Member of the Class of 1986 (celebrating 40th anniversary) Member of the Class of 2001 (celebrating 25th anniversary) Congratulations! As a member of a celebrating class, you will receive a milestone gift from the college. You may choose either a #1 Quarter-Zip pullover embroidered with your graduating class year - Please include your mailing address, class year and shirt size OR #2 Glass trophy engraved with your anniversary year. Visit our celebration page for samples of each gift. What gift would you like to receive in celebration of this milestone? Please provide your complete mailing address so we can send you your selected gift Would you like to make an additional gift? Would you like to make an additional gift? Yes No Please enter an amount for your additional gift to the KSUCPM Student Scholarship Fund: Payment Amount Is Primary Is Primary Yes No Guest Cost Passthrough Guest Deductibility Passthrough Ticket Type Passthrough

Add a Guest

Additional Information:

Kent State University is committed to making its work environment, programs and activities accessible for individuals with disabilities. Please indicate if you need accommodations to fully participate in this event by contacting Madalynne Stanic Fitzgerald at mstanic2@kent.edu or through the text box below:

Are you using a business credit card?*

Yes

No

Please enter your company name*

Billing Information:

Country

Street

City

Region

Postal Code

Make this a recurring payment
Repeat payment
Recurring start date
Amount Due
Loading...

Make this a recurring payment

Amount Due

Loading...