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Package Name Amount Quantity Subtotal

1 Full Page Color Digital & Print Ad $0.00

1 Full Page Color Program Ad $0.00

1 Full Page Color Digital Ad $0.00

1 Half-Page Black & White Program Book Ad $0.00

1 Full Page Black & White Program Book Ad $0.00
Registration opens: Friday, February 13, 2026
Registration closes: Tuesday, May 5, 2026

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I authorize Self-Help for the Elderly to use the credit card entered on the submission page at event 2026 Longevity Gala. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.