Dinner admin August 24, 2016 March 4, 2021 Something Wrong while submiting form.Form Submission is restrictedForm is successfully submitted. Thank you!53rd Dinner Sunday March 15th 5:30 PM Dinner & Comedy showYISI 53rd Annual Dinner Sunday March 15th 5:30 PM Dinner & Comedy Show Celebrating our Past, Present and FutureI would like to reserveseats at the YISI 53rd Annual DinnerChoose the type*$125 - I cannot attend the Dinner but wish my family to be listed on the plaque$250 - General Admission for Young Community$300 - General Admission (per couple)$360 Bronze - Admission with one family listing on Plaque$500 Silver - Admission, Silver listing, VIP seating$750 Gold - Admission, Gold listing, VIP seating$1000 Diamond - Admission, Diamond listing, VIP seatingPlease list family name exactly how it should appear on the Scroll of Honor:*Payments*---select---Please selectCheckCredit CardFirst Name*Last Name*Email*Address*City*State*---Select State---Please selectAlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code*Phone*Only numbers, no parenthesis or dashesPayment Type*---Select Card---Please selectVisaAmexMasterCardCard Number*CVV Code*Expiration Month*JanuaryJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberExpiration Year*202120212022202320242025202620272028202920302031203220332034203520362037203820392040Amount: $ Submit