REGISTRATION Supporting Tomorrow’s Health Today Step 1 of 3 33% First Name* Last Name* Address 1* Address 2 City* State/Territory* ZIP/Postal Code* Country*Please Select...United StatesIsraelAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweEmail* Enter Email Confirm Email Cell Phone* Order Type* Tickets and Packages Can’t attend but wish to donate DonationI would like to make a donation of Tickets and PackagesPackages and Tickets* OASIS-IN-THE-DESERT - $180,0003 Up to 3 VIP tables of 10, a Cover Platinum Journal Ad and a Naming Plaque at Soroka FLOWER OF THE DESERT - $50,000Up to 2 VIP tables of 10, a Platinum Journal Ad and a Naming Plaque at Soroka BUILDER OF THE FUTURE - $36,000 Up to 1 VIP table of 10 and a Platinum Journal Ad VISIONARY PARTNER - $18,000Up to 1 VIP Table of 10 and a Gold Journal Ad DISCOVERY PARTNER - $10,000Up to 1 table of 10 and a Silver Journal Ad PIONEER PARTNER - $5,000Up to 4 VIP seats and a Gold Journal Ad LEADERSHIP PARTNER - $3,600Up to 2 VIP seats and a Gold Journal Ad SOROKA CHAMPION - $1,800Includes 1 VIP seat and a Silver Journal Ad Individual Gala Ticket(s)$1,000 Per Gala Ticket Individual Young professional Ticket(s)$360 Per Gala Ticket (age 36 and younger) Gala Ticket(s)* Price: $1,000.00 Quantity: Young professional Ticket* Price: $360.00 Quantity: Would you like to include a Tribute Journal? Yes Tribute Journal Options BACK COVER SPONSOR INSIDE COVER PLATINUM FULL PAGE GOLD HALF PAGE SILVER QUARTER PAGE BRONZE Would you like to make an additional donation in support of this event? Yes Donation Amount Total $0.00 Payment Type By Credit Card By Mailing a Check Credit Card InformationOrder Total $0.00 Credit CardCard Details Cardholder Name Please make check out to and mail to the following address: American Friends of Soroka Medical Center PO Box 184-H Scarsdale, NY 10583I understand* I will mail a check to the address and in the amount of the order total below. Order Total $0.00 NameThis field is for validation purposes and should be left unchanged.