test Please enable JavaScript in your browser to complete this form.Name *FirstLastCompany NameIf your purchase is for a Business or Corporation.AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome PhoneWork PhoneEmail *How did you hear about this event?Friend or colleagueRadio / TVSocial MediaOtherPlease Select the Number of Tickets You Would Like to Purchase *Select OneSingle TicketTwo TicketsThree TicketsFour TicketsFive TicketsSix TicketsSeven TicketsEight TicketsNine TicketsTen TicketsSUNDAY, SEPTEMBER 23 | 6:00 T O 8:00 PM JOIN JILL GHALEB FOR A SUSQUEHANNA ANIMAL SHELTER FUNDRAISER IN MEMORY OF DR. HANY GHALEB on THE VERANDA OF THE OTESAGA HOTEL $100 includes : 2 drinks & heavy hors d’oeuvres & SILENT AUCTIONAdditional Donation Please enter your additional donation amount in the area above.Payment OptionsI would like to pay by check (Due by 9/16 - Mail to SAS, 4841 State Hwy. 28, Cooperstown, NY 13326I would like to pay with a credit card (Processed securely through PayPal - Account not required)Total$ 0.00CommentSubmit