Take Back the Night Registration

Fields marked * require an entry.

A fundraiser for Sexual Assault Response Services

Package Name	Amount	Subtotal

Event Registration	$25.00	$0.00

This registration includes a t-shirt, bag of goodies, and Birdie Safety Alarm.

Free Registration	$0.00	$0.00

Free registration will help you get checked in at the event to recieve a bag of goodies which includes a flashlight.

I would like to make a donation

Donation Amount:

I would like my donation to recur:

Yes

Amount you would like to recur:

Frequency of donation:

Number of recurrences:

Date of your final recurring donation:

Please confirm recurring donation:

Total:

$0.00

Peace at Home is a non-profit serving Douglas County, Oregon (Tax ID 93-0771154).

The 1st Annual Take Back the Night Event's goal is to raise awareness
about how a community can support survivors of sexual violence.