2021 Gala Club Account Purchase

Thank you for registering to join us! Please complete and submit the form below to pay for your ticket/sponsorship by Union League Club account.

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Ticket Options

Please select from the following ticket options.

Individual Ticket

Price: $350.00

Table of 10

Price: $3,350.00

Discounted Individual Ticket - *Available for our ULBGC Associate Board, Associate Board Council, ULC Younger Members and ULBGC Alumni*

Price: $275.00

Sponsor a Staff Member to Attend

Price: $150.00

Payment & Additional Information

Please complete the following

Have you completed your COVID vaccination (i.e. have you received the final dose 14 days ago or longer)? You will receive a separate form asking about vaccinations to share with your guests for them to complete as well.(Required)

Yes

No, but I plan to prior to the event

Please select your preferred payment method.(Required)

Union League Club Account

Check (see text below for the payable information and mailing address)

If paying by check, please make it payable to "Union League Boys & Girls Clubs" and mail it to 65 W Jackson Blvd, Chicago, IL 60604 and make it to the attention of "Marina Del Cid".

If paying by Union League Club account, please enter your member number here.

This form is confidential and the account number will only be used for this one charge.

If paying by Union League Club account, please check the box below to authorize us charging your account.

By checking this box, I hereby authorize Union League Boys & Gils Clubs to charge my Union League Club account for the dollar amount I listed above

If you are also bringing/inviting guests, and you know their names, please enter them here.(Required)

If anyone in your party has any dietary restrictions, please enter them here. Enter "N/A" if not applicable.(Required)