2026 Annual Meeting Registration Form

Heartland United Way's Campaign Celebration & Annual Meeting

First

Last

Suffix

If applicable, what business/organization do you represent?

This will be used for your confirmation email.

Phone

Mailing Address

City

State

ZIP Code

Purchasing

Sponsor a Table of 8 ($500)

includes meal for 8 people

Individual Tickets ($45/each)

Number of Tickets ($45/each)

Attendee #1

Guest names and emails are not required to submit the form, however are helpful if known. If any guests are in need of food accommodations, please note it below. Please be sure to include yourself if attending.

First Name

Last Name

Provide Dietary Restrictions

Attendee #2

First Name

Last Name

Provide Dietary Restrictions

Attendee #3

First Name

Last Name

Provide Dietary Restrictions

Attendee #4

First Name

Last Name

Provide Dietary Restrictions

Attendee #5

First Name

Last Name

Provide Dietary Restrictions

Attendee #6

First Name

Last Name

Provide Dietary Restrictions

Attendee #7

First Name

Last Name

Provide Dietary Restrictions

Attendee #8

First Name

Last Name

Provide Dietary Restrictions

Transaction Details

Are you willing to cover the 3% credit card processing fee?

Yes

Payment