Pelvic Health Awareness Event H.O.P.E Foundation Registration Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Work PhoneHome/Cell Phone*Email* Seminar confirmation will be sent to this email.How did you find out about the presentation?* Email announcement Facebook Instagram Hands on OT website What's app Print ad Friend Comments or special requestsWhat amount would you like to donate?*Prepayment Donation - by December 15th - $25Suggested Donation- $36Reserved Premium Seating - $50Bronze Donation - $75Silver Donation - $150Gold Donation - $250PLEASE NOTE - SPACE IS LIMITED AND ONLY THOSE WHO SUBMIT A MINIMUM DONATION PRIOR TO THE REGISTRATION DATE WILL BE ALLOWED IN. FOR CEUs: Be sure to email email@example.com in order to receive a special registration link that is required to qualify for continuing education credits. Additional Donations. Please type below the additional amount you would like to contribute. Thank you! All donations are tax deductible and 100% of donations will be going to direct services under the H.O.P.E. Foundation, a 501(c)3 organization. Total $0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.