Bay Area Bruins: Welcome to the Bay

RSVP Information

Registration
Select	Description	Amount

Event Tickets - $5

Sub-Total:
Tax-Deductible:

Donation Option

I would like to make an additional donation to the Bay Area Bruins/Marijane Viat Memorial Endowment Fund.

If you do not want to register for this event, but would like to make a donation, please click here

I would like to make a fully tax-deductible gift of * Other $ *

Grand Total:

Tax-Deductible:

Contact Information

Personal

Title:

First name:

Middle name:

Last name:

Suffix:

I am making this gift as a proxy for my organization/company, which should be recognized as the legal donor

UCLA graduation year(s):

Contact Information

Street:

U.S. Addresses

City, State, Zip:

Non-U.S. Addresses

Non-U.S. City/County
or Province/Postal Code:

Country:

This address is my:

Home

Business

Home telephone:

Invalid phone number *

Business telephone:

Invalid phone number

E-mail address:

This e-mail is my:

Home

Business

Payment

Payment method:

Credit Card PayPal

Additional Information

	Job Title:
	Company Name:
	Please let us know if anyone in your party needs ADA accommodations:
	Please let us know if anyone in your party has any dietary restrictions:
	* UCLA Affiliation:	*
Guest Information The following fields are required for all of your additional guests. If you are the main registrant, no need to include yourself below as we have your information above.
Your First Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
Your Second Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
Your Third Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
Your Fourth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
Your Fifth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
Your Sixth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
Your Seventh Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation::
Your Eighth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* UCLA Affiliation:
Your Ninth Guest:
	* First Name:
	* Last Name:
	* Email address:
	* Alumnus/a of UCLA?:
	UCLA graduation year:

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