Texas Alliance for Life
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Reserve My Table or Seat
Reserve My Table or Seat
Fill out this form completely to make a table reservation or purchase individual seats for the Annual Benefit Dinner by Friday, September 23.
Prefix
Mr.
Mrs.
Mr. & Mrs.
Ms.
Dr.
Rev.
Fr.
Pastor
Honorable
First
*
Last
*
Suffix
Sr.
M.D.
RN
LVN
Ph.D.
JD
DDS
CPA
MS
MA
Phone
*
Email
*
Address
*
City
*
State
*
Zip
*
Are You a Current Leadership Circle Member
*
Yes
No
Are You a Sustaining Member
*
Yes
No
What is Your Leadership Circle Membership Level
*
Governor - $10,000 annually
Lt. Gov. - $5,000 annually
Senator - $2,500 annually
Representative - $1,200 annually
What is Your Sustaining Membership Level
*
Choose Level
Champion - $50 monthly
Advocate - $25 monthly
Champion level Sustaining Members can claim two dinner seats and two places at the VIP reception. Advocate level Sustaining Members can claim two dinner seats.
Choose Your Table or Seat
*
Platinum Level - $8,000.00
Gold Level - $4,000.00
Silver Level - $2,000.00
Bronze Level - $1000.00
Individual Seat - $100.00
2 Individual Seats - $200.00
3 Individual Seats - $300.00
4 Individual Seats - $400.00
None of the Above
Your Table or Reservation Name
*
Recipient Organization
*
Texas Alliance for Life, Inc.
(For legislative efforts, not tax-deductible; may be used for supporting or opposing federal candidates.)
Texas Alliance for Life Trust Fund
(For education and litigation efforts, tax-deductible.)
Texas Alliance for Life State Political Action Committee (TAL State PAC)
(To help elect state and local pro-life candidates, not tax-deductible.)
Texas Alliance for Life Federal Political Action Committee (TAL Fed PAC)
(To help elect federal pro-life candidates, not tax-deductible.)
Occupation and Employer
*
Total
$0.00
Credit Card
*
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Expiration Date
Security Code
Cardholder Name
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