You are invited to a special fund raising event to support Genesys Health Foundation’s three-year, $300,000 campaign to fund robotic surgery technology for the state-of-the-art Surgery Services at Genesys Regional Medical Center.

Please complete this online registration form completely:

Number of attendees: ($125 per ticket)
Name:

Address:

City, State and Zip



Media Sponsors:
   
E-mail address
Phone number



$


Credit Card Number:
Expiration Date:
Card Type
/
Security code: (on back of card)


Wear your casual attire and come prepared to have a great time!
Questions? Please call (810) 606-7909.