12th Annual Kick Up Your Heels

Name and Contact Information

First Name *

Last Name *

Email Address *

Primary Phone

Residential Address *

City *

Postal Code *

Province *

Country *

Declaration *

Yes, I agree to the declaration below. *

* I declare that I am using my personal credit card / bank account to donate on my own behalf, and I am a BC resident and Canadian citizen or permanent resident. (To be an eligible donor to the BC NDP, you must use your personal credit card / bank account to donate on your own behalf, and you must be a BC resident and Canadian citizen or permanent resident).

VIP Diva Ticket

CA$100.00
Please enter # of tickets you want to purchase.

Regular Ticket

CA$75.00
Please enter # of tickets you want to purchase.

VIP Diva Table of 10

CA$1,000.00
Please enter # of Diva Tables you want to purchase. (1=10 tickets)

Early Bird - Surrey Green Timbers

CA$60.00

Early Bird - Burnaby Lougheed

CA$60.00

Diva Ticket - Van Kensington

CA$100.00

Total

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Name and Residential Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *