Human Dignity Awards Registration

Donation Amount*
  • $1750 - table of 10 seats
  • $1500 - 4 premium seats + ad
  • $700 - 2 premium seats + name listing
  • $350 - 2 seats
  • $175 - 1 seat
  • Other $

CAN'T ATTEND? You can make a gift by using the "Other" line above. You may also sponsor a survivor to attend by donating $150.  

 

DON'T SEE EXACTLY WHAT YOU WANT? Download the Sponsorship Form above and use the "Other" line above to make your total payment. Use the "My Note to PTV" section at the bottom of the form to explain. 

 

QUESTIONS? Please contact Cam Vu at cvu@ptvla.org or 213 384-4788 ext. 234.

 

My Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

*This personal information is required for a credit card payment and your email is required so that we may send you an email confirmation and receipt. Don't worry, we do not sell or share your personal information to anyone outside of PTV. To enable confidence and transparency, PTV's Donor Privacy Policy is available for review on our Annual Reports/Financials page.

Special Meal Request

The standard entree served at the dinner will be chicken (gluten free). As alternatives we have Vegetarian pasta or Kosher fruit bowl. SKIP IF YOU WOULD LIKE CHICKEN.

# of Vegetarian or Kosher Meals (1 to 10)

My Payment

Amount*
$
Name on Card*
Card Number*

My Note To PTV

Additional Comments

Security Code