Doctors Manitoba | Awards Gala Ticket Purchase (Member)

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Awards Gala Ticket Purchase (Member)

Title *

First Name *

Last Name *

Email *

Email address where you would like payment confirmation and ticket details sent.

Award Gala Ticket Purchase

You can purchase individual tickets for $150 each, or a full table of 10 for $1350. (Please note that only Visa and Mastercard are accepted.)

Number of Individual Tickets

Number of Tables

If you have purchased a table, how do you want it titled? (eg. Rady Faculty of Medicine)

Guest Information

Please complete the following information about each guest. A meal preference is required now for each ticket, but guest names can be added later if not yet confirmed.

Note: on mobile devices, you may need to scroll to the right to be able to specify meal preferences, allergies and dietary restrictions for each guest.

Title *	First Name *	Last Name *	Meal Preference *	Allergies *	Dietary Restrictions *

Seating Preference (optional)

Please indicate if you want to be seated with other individuals attending the event not included in this order. Include their names, and will do our best to seat you together.

Sponsor a Medical Learner (optional)

You can sponsor a medical learner to attend our awards celebration, and with your consent you will be recognized for this generous support. We will work with the MMSA and PARIM to identify medical learners interested in attending. Medical learners are the future of our profession and including as many of them as possible in this event helps to build relationships and offer inspiration for excellence as they transition into practice.

Number of Medical Learner Sponsorships

Tickets are $150 each

Do you consent to being recognized as a sponsor at the awards celebration?

Yes

Optional: If desired, please add the names and email addresses of medical learners you wish to sponsor below.

Medical Learners

Total

Billing Details

Please note that only Visa and Mastercard are accepted. Sorry for any inconvenience.

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Last Name *

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Address Line 2

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Postal Code *

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Awards Gala Ticket Purchase

Award Gala Ticket Purchase

Sponsor a Medical Learner (optional)

Billing Details