Repair the World Ticketed Program Signup

Please use this form to signup for the below program. The suggested ticket prices are described in "About the Program" below, and you can select your option by editing the value in the "Amount" field.

If cost is a barrier to entry, please contact the person referenced below in "About the Program."

We look forward to welcoming you to Repair the World's programming.

Program Information

Program Title

Program Date

Spots Remaining

Venue Name

Venue Address

About the Program

Join Repair the World Miami, Ladies Empowerment and Action Program (LEAP), and Exchange for Change for a meaningful evening of learning and community! We will be engaging in a conversation about the empowerment of currently and formerly incarcerated individuals, responding to poetry written by folks in Exchange for Change's writing program, and connecting with each other over mocktails. 

Mocktails and light snacks will be served. The cost for the event is $6.00. If cost is a barrier to joining this event, please reach out to Bianka Bermudez at bianka.bermudez@weRepair.org.

Participant Information

Participant First Name

Participant Last Name

Personal Email

You'll receive emails from Repair the World. You may unsubscribe at any time.

Cell Phone Number

Street Address

City

State

Zipcode

Ticket Information

Amount: $

Please format your amount with cents, i.e. XX.XX

Would you like to cover the credit card processing fee of 2.5%?

YesNo

Total Amount: $

Payment Information

I am the cardholder

Cardholder First Name

Cardholder Last Name

Billing Email

Cardholder First Name

Cardholder Last Name

Billing Email

Credit Card Type

Card Number

Code

IDs

Community ID

GAU ID

Opportunity ID

Contact ID

Account ID