Registration template

Registration Template

“Event Title” The next SDRIC Gathering will be on Tuesday, September 20 and will focus on the topic of Opioid Addiction, Fentanyl, and Overdoses with Narcan. 5:30 to 8:00 pm; Location TBD. Cost: $25 which includes dinner. If this presents a hardship, contact SDRIC for financial assistance by emailing sdricinterfaith@gmail.com. Speaker(s): Rockwell “Rocky” Herron (Confirmed) (Bio below) Evan Hodges, Community Health Worker Liaison – County of San Diego Office of Equitable Communities & Homeless Solutions Beverly Monroe, Executive Director – House of Metamorphosis, Inc.

First Name(Required)

Last Name(Required)

Email(Required)

Organization(Required)

Title(Required)

Geographical Area of Your Religious Activity(Required)

How Did You Hear About the Event?(Required)

For example: email, newsletter, Facebook, word of mouth, SDRIC website, etc.

Number in your In-Person Party ($25, includes meal)

Number in your On-Line Party

Total Registration Fee

Price: $ 0.00

Dietary Restrictions for In-Person Meal

Please enter None, Vegetarian, Vegan, Kosher, Halal, Gluten-Free, etc.

Guest Names and Their Dietary Restrictions

If you are registering others for In-Person on this form, please list their name(s) and any dietary restrictions.

Registering for In-Person and/or Making a Donation?

Yes

If making a donation, please enter the amount here

Help Offset Service Fee (30 cents plus 3%)?

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No Fee

Amount of Added Service Fee, if any

Price: $ 0.00

Total

Please confirm your payment amount(Required)

Yes, the number in Total is the correct amount to charge my card

Credit Card

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Card Number

Expiration Date

Security Code Cardholder Name