victimservicecenter.org
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urlscan Pro
192.124.249.6
Public Scan
Submitted URL: https://r20.rs6.net/tn.jsp?f=00153pY3OIlcXIiN34HpsBBQlmqYND-wRJr-hvT6IixKnl1VSKzp0OnjIa7U_i0sqcNRS0A7lk6TAEmms9fM2Ad...
Effective URL: https://victimservicecenter.org/sponsorship/
Submission: On December 13 via manual from US — Scanned from DE
Effective URL: https://victimservicecenter.org/sponsorship/
Submission: On December 13 via manual from US — Scanned from DE
Form analysis
2 forms found in the DOMPOST
<form id="registration-form" class="registration-form" method="post" onsubmit="event.preventDefault(); collectPayment();">
<div class="errors hidden"></div>
<div class="section registrationType">
<h3>Cheers to Change 2024 Registration</h3>
<div class="field radio 6867969 required"><label for="6867969"><input id="6867969" name="registration-type" class="required" type="radio" value="7500.000000" maxlength="255" data-short-name="Platinum Sponsor" data-ticket-quantity="18"
data-registration-type-value="56324" data-non-deductible-amount="0.000000"><span class="label">$7,500.00 - Platinum Sponsor</span></label></div>
<div class="field radio 6867970 required"><label for="6867970"><input id="6867970" name="registration-type" class="required" type="radio" value="5000.000000" maxlength="255" data-short-name="Gold Sponsor" data-ticket-quantity="16"
data-registration-type-value="56325" data-non-deductible-amount="0.000000"><span class="label">$5,000.00 - Gold Sponsor</span></label></div>
<div class="field radio 6867971 required"><label for="6867971"><input id="6867971" name="registration-type" class="required" type="radio" value="2500.000000" maxlength="255" data-short-name="Silver Sponsor" data-ticket-quantity="14"
data-registration-type-value="56326" data-non-deductible-amount="0.000000"><span class="label">$2,500.00 - Silver Sponsor</span></label></div>
<div class="field radio 6867972 required"><label for="6867972"><input id="6867972" name="registration-type" class="required" type="radio" value="1000.000000" maxlength="255" data-short-name="Bronze Sponsor" data-ticket-quantity="8"
data-registration-type-value="56327" data-non-deductible-amount="0.000000"><span class="label">$1,000.00 - Bronze Sponsor</span></label></div>
<div class="field radio 6867975 required"><label for="6867975"><input id="6867975" name="registration-type" class="required" type="radio" value="100.000000" maxlength="255" data-short-name="Individual Ticket" data-ticket-quantity="1"
data-registration-type-value="5278721" data-non-deductible-amount="0.000000"><span class="label">$100.00 - Individual Ticket</span></label></div>
<div class="field radio cannot-attend required"><label for="cannot-attend"><input id="cannot-attend" name="registration-type" class="required" type="radio" maxlength="255" data-short-name="Donation" data-registration-type-value="55299"><span
class="label">Sorry, I can't attend, but I would like to show my support by making a donation</span></label></div>
</div>
<div class="section registrationSummary">
<table class="registration-summary" style="display: none" data-registration-type-field-id="66560" data-ticket-quantity-field-id="54275">
<tbody>
<tr>
<th class="quantity-column">Quantity</th>
<th class="description-column">Type</th>
<th class="tickets-column">Tickets</th>
<th class="price-column">Price</th>
</tr>
<tr class="summary-row">
<td><input id="numberOfRegistrations" type="number" class="required integer minimum1" value="1"> × <label for="numberOfRegistrations" class="error" style="display: none" generated="true"></label></td>
<td><span id="shortDescription"></span></td>
<td><span id="ticketQty"></span></td>
<td><span id="unitPrice"></span></td>
</tr>
<tr class="additional-donation">
<td></td>
<td>Additional Donation</td>
<td></td>
<td><input id="additional-donation-amount" name="additionalDonationAmount" type="text" class="currency amount-field minimum1" placeholder="$0.00"> <label for="additional-donation-amount" class="error" style="display: none"
generated="true"></label></td>
</tr>
<tr class="cannot-attend-donation" style="display: none">
<td></td>
<td>Donation</td>
<td></td>
<td><input id="cannot-attend-amount" name="cannotAttendAmount" type="text" class="currency amount-field required minimum1" placeholder="$0.00"> <label for="cannot-attend-amount" class="error" style="display: none" generated="true"></label>
</td>
</tr>
<tr class="summary-total">
<td>Total:</td>
<td></td>
<td><span id="totalTicketQty">0</span></td>
<td><span id="totalPrice">$0.00</span></td>
</tr>
</tbody>
</table>
</div>
<div class="section contact">
<h3>Contact Information</h3>
<div class="field text first-name required"><label for="first-name"><span class="label">First Name</span><span class="required-star">*</span></label><input id="first-name" name="first-name" class="required" type="text"></div>
<div class="field text last-name required"><label for="last-name"><span class="label">Last Name</span><span class="required-star">*</span></label><input id="last-name" name="last-name" class="required" type="text"></div>
<div class="field email email-address required"><label for="email-address"><span class="label">Email</span><span class="required-star">*</span></label><input id="email-address" name="email-address" class="email required" type="email"
placeholder="someone@website.com"></div>
<div class="field tel phone-number"><label for="phone-number"><span class="label">Phone</span></label><input id="phone-number" name="phone-number" class="phoneUS" type="tel"></div>
</div>
<div class="section billing-address">
<h3>Billing Address</h3>
<div class="field country required"><label for="country">Country<span class="required-star">*</span></label><select id="country" name="country" class="required">
<option value=""></option>
<option value="AF">Afghanistan</option>
<option value="AX">Aland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Democratic Republic of the Congo</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Cote d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curacao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="SZ">Eswatini</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Islamic Republic of Iran</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Democratic People's Republic of Korea</option>
<option value="KR">Republic of Korea</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Federated States of Micronesia</option>
<option value="MD">Republic of Moldova</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">State of Palestine</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthelemy</option>
<option value="SH">Ascension and Tristan da Cunha Saint Helena</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">United Republic of Tanzania</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US" selected="">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vatican City</option>
<option value="VE">Venezuela</option>
<option value="VN">Viet Nam</option>
<option value="VG">British Virgin Islands</option>
<option value="VI">U.S. Virgin Islands</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select></div>
<div class="field street-address required"><label for="street-address"><span class="label">Address</span><span class="required-star">*</span></label><textarea id="street-address" name="street-address" class="required"></textarea></div>
<div class="field text city required"><label for="city"><span class="label">City</span><span class="required-star">*</span></label><input id="city" name="city" class="required" type="text" data-us-label="City" data-bm-label="Parish"></div>
<div class="field state required"><label for="state">State<span class="required-star">*</span></label><select id="state" name="state" class="required">
<option value=""></option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AS">American Samoa</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="AE">Armed Forces Africa, Canada, Europe, Middle East</option>
<option value="AA">Armed Forces Americas (except Canada)</option>
<option value="AP">Armed Forces Pacific</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DE">Delaware</option>
<option value="DC">District of Columbia</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="VI">US Virgin Islands</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select></div>
<div class="field province required" style="display: none"><label for="province">Province<span class="required-star">*</span></label><select id="province" name="province" class="required">
<option value=""></option>
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NL">Newfoundland and Labrador</option>
<option value="NT">Northwest Territories</option>
<option value="NS">Nova Scotia</option>
<option value="NU">Nunavut</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="QC">Quebec</option>
<option value="SK">Saskatchewan</option>
<option value="YT">Yukon Territory</option>
</select></div>
<div class="field number zip-code required"><label for="zip-code"><span class="label">ZIP Code</span><span class="required-star">*</span></label><input id="zip-code" name="zip-code" class="zipcodeUS required" type="number" minlength="5"
maxlength="10"></div>
<div class="field text postal-code required" style="display: none"><label for="postal-code"><span class="label">Postal Code</span><span class="required-star">*</span></label><input id="postal-code" name="postal-code" class="required" type="text">
</div>
</div>
<div class="section payment">
<h3>Payment Information</h3>
<div class="field radio Savings required"><label for="Savings"><input id="Savings" name="payment-type" class="required" type="radio" maxlength="255"><span class="label">Savings</span></label></div>
<div class="field radio Checking required"><label for="Checking"><input id="Checking" name="payment-type" class="required" type="radio" maxlength="255"><span class="label">Checking</span></label></div>
<div class="field radio CreditCard required"><label for="CreditCard"><input id="CreditCard" name="payment-type" class="required" type="radio" maxlength="255"><span class="label">Credit Card</span></label></div>
<div class="field number routingNumber required" style="display: none"><label for="routingNumber"><span class="label">Routing Number</span><span class="required-star">*</span></label><input id="routingNumber" name="routing-number"
class="required" type="number" maxlength="255"></div>
<div class="field number accountNumber required" style="display: none"><label for="accountNumber"><span class="label">Account Number</span><span class="required-star">*</span></label><input id="accountNumber" name="account-number"
class="required" type="number" maxlength="255"></div>
</div>
<div class="section custom-fields">
<h3>Additional Information</h3>
<div class="field text CustomAccountField_62465"><label for="CustomAccountField_62465"><span class="label">Company Name</span></label><input id="CustomAccountField_62465" name="CustomAccountField_62465" type="text" maxlength="255"></div>
<div class="field text CustomAccountField_62466"><label for="CustomAccountField_62466"><span class="label">Company Contact</span></label><input id="CustomAccountField_62466" name="CustomAccountField_62466" type="text" maxlength="255"></div>
<div class="field text CustomAccountField_62467"><label for="CustomAccountField_62467"><span class="label">Company Contact Email</span></label><input id="CustomAccountField_62467" name="CustomAccountField_62467" type="text" maxlength="255"></div>
<div class="field text CustomAccountField_59393"><label for="CustomAccountField_59393"><span class="label">Company Contact Phone Number</span></label><input id="CustomAccountField_59393" name="CustomAccountField_59393" class="number" type="text"
maxlength="255"></div>
</div>
<div class="section comment">
<div class="field text comment"><label for="comment"><span class="label">Comments</span></label><textarea id="comment" name="comment" type="text" value="Comments"></textarea></div>
</div>
<div class="section consent hidden">
<div class="field checkbox consent-all"><label for="consent-all"><input id="consent-all" name="consent-all" type="checkbox" maxlength="255"><span class="label">I would like to receive or continue receiving updates from Victim Service Center of
Central Florida</span></label></div>
<div class="field checkbox consent-email" style="display: none"><label for="consent-email"><input id="consent-email" name="consent-email" type="checkbox" checked="checked" maxlength="255"><span class="label">by email</span></label></div>
<div class="field checkbox consent-mail" style="display: none"><label for="consent-mail"><input id="consent-mail" name="consent-mail" type="checkbox" checked="checked" maxlength="255"><span class="label">by postal mail</span></label></div>
<div class="field checkbox consent-phone" style="display: none"><label for="consent-phone"><input id="consent-phone" name="consent-phone" type="checkbox" checked="checked" maxlength="255"><span class="label">by phone</span></label></div>
</div>
<div class="section true-impact">
<h3>Increase My Impact</h3>
<div class="field checkbox true-impact"><label for="true-impact"><input id="true-impact" name="true-impact" type="checkbox" maxlength="255"><span class="label">Add <span class="fee-amount">$0</span> to help cover our transaction
fees</span></label></div>
</div>
<div class="section captcha"> <label id="noCaptchaResponseError" class="error noCaptchaResponseError" style="display: none">You must fill out the CAPTCHA</label>
<div id="captcha6863872">
<div style="width: 304px; height: 78px;">
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Skip to content English | Espanol 24-HOUR HOTLINE: 407-500-HEAL (4325) Exit Donate Now * Home * Letter from Lui Damiani * About Us * Our Story * VSC Board of Directors * Meet the VSC Team * Join the Team * Annual Reports & Brochures * Ways to Give * Get Help * Sexual Assault Services * Forensic Examinations – Rape Kits * Crime Victim Services * Therapy & Support Services * Community Resources * Client Forms * Education/Prevention * Prevention Education * #BeTheHero * Blogs * Podcast & TV * Get Involved * Cheers to Change * Lunch and Learn * Volunteer * #DenimDay * Contact Us Cheers to Change 2024 CHEERS TO CHANGE 2024 VICTIM SERVICE CENTER OF CENTRAL FLORIDA IS EXCITED TO ANNOUNCE OUR LARGEST EVENT, THE 11TH ANNUAL CHEERS TO CHANGE, AN ANNUAL FUNDRAISER SUPPORTING SURVIVORS IN THE CENTRAL FLORIDA COMMUNITY! SAVE THE DATE. THE EVENT WILL TAKE PLACE ON FRIDAY, APRIL 5TH, 2024 FROM 6-9:30PM AT THE ORLANDO SCIENCE CENTER FILLED WITH INSPIRING STORIES AND EXCITING ENTERTAINMENT YOU DON’T WANT TO MISS. PLEASE CONSIDER BECOMING A SPONSOR FOR THIS VERY SPECIAL EVENT! MAKE IT AN EVENING OF GIVING AS YOU SUPPORT THE VSC AND UPLIFT VICTIMS BY DONATING AN ITEM TO OUR SILENT AUCTION. 2023 SPONSORSHIP LEVELS * * * * 1. 1 2. 2 * Previous * Next CHEERS TO CHANGE 2024 REGISTRATION $7,500.00 - Platinum Sponsor $5,000.00 - Gold Sponsor $2,500.00 - Silver Sponsor $1,000.00 - Bronze Sponsor $100.00 - Individual Ticket Sorry, I can't attend, but I would like to show my support by making a donation Quantity Type Tickets Price × Additional Donation Donation Total: 0 $0.00 CONTACT INFORMATION First Name* Last Name* Email* Phone BILLING ADDRESS Country*AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoDemocratic Republic of the CongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIslamic Republic of IranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiDemocratic People's Republic of KoreaRepublic of KoreaKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoFederated States of MicronesiaRepublic of MoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauState of PalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemyAscension and Tristan da Cunha Saint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanUnited Republic of TanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaViet NamBritish Virgin IslandsU.S. Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabwe Address* City* State*AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces Africa, Canada, Europe, Middle EastArmed Forces Americas (except Canada)Armed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUS Virgin IslandsUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Province*AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory ZIP Code* Postal Code* PAYMENT INFORMATION Savings Checking Credit Card Routing Number* Account Number* ADDITIONAL INFORMATION Company Name Company Contact Company Contact Email Company Contact Phone Number Comments I would like to receive or continue receiving updates from Victim Service Center of Central Florida by email by postal mail by phone INCREASE MY IMPACT Add $0 to help cover our transaction fees You must fill out the CAPTCHA PROCESSING... Your transaction is being processed. Please do not close your browser or leave this page. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE (800-435-7352) WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. YOUR GIFT IS TAX DEDUCTIBLE AS ALLOWED BY LAW; VICTIM SERVICE CENTER IS REGISTERED WITH THE STATE UNDER THE SOLICITATION OF CONTRIBUTIONS ACT, 1992 UNDER FLORIDA REGISTRATION NUMBER CH18390 AND FEDERAL TAX IDENTIFICATION NUMBER 75-2978885. FOR REGISTRATION INFORMATION CONTACT THE DIVISION OF CONSUMER SERVICES AT 1-800-HELP-FLA (435-7352) OR VISIT THEIR WEBSITE AT WWW.FLORIDACONSUMERHELP.COM. WHO ARE WE? Victim Service Center of Central Florida is the Certified Rape Crisis Center in Orange, Osceola and Seminole Counties. 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