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 22.

Prefix
First*
Last*
Suffix
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*
What is Your Sustaining Membership Level*
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*
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 Expiration Date Security Code Cardholder Name
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