2014 Circle of Care Gala Registration

Form Description

A Tented Event at The Health Education Center
PeaceHealth St Joseph Medical Center Campus
3333 Squalicum Parkway
Bellingham, WA 98225


Fill in the information below. Use the scroll bar on the right to move down the page. When finished, click the Save button located at the bottom of the form. Questions marked with a red * require a response.

Guest Information
Note: If you are a hosting a table our team will be contacting you requesting names and menu selections for guests.
Menu Options
*all menu items are gluten free

Payment Method


If you prefer to pay by check or have already been taken care of, please enter 0 in the "amount to charge credit card" box.

If paying by Check:
PeaceHealth St. Joseph Medical Center Foundation
Mailing Address:
PeaceHealth St. Joseph Medical Center Foundation
2901 Squalicum Parkway
Bellingham, WA 98225
Phone: (360) 788-6866

Online Credit Card Payments:
Please calculate number of attendees x $200 each.
Or, if you cannot attend: Regret, please accept my tax deductible donation of $

If you would like a copy of this completed form, please enter your email address.
Email:  * 
Amount to charge credit card:
After saving this form, you will be asked for credit card information.