2021 Poker Test form

Ticket/Table Levels

$500 - General Admissions Poker Ticket: Admission into virtual poker tournament and donor recognition in the digital event program.$700 - Ante Up Poker Ticket: Includes donor listing in digital program and one pre-paid rebuy at a discounted rate.$1,000 - Royal Flush Ticket: Includes a mailed gift package; donor listing in digital program and two pre-paid rebuys at a discounted rate.$7,500 - Poker Table: 9 Ante Up tickets + 1 Royal Flush ticket for the host which includes donor listing in digital program.Absentee Gift - I can not attend but would like to contribute.

Number of Tickets (for a table, please select number of tables)

Have you ever played in an online poker tournament before?

I am unable to attend, but wish to contribute $

First Name

Last Name

Company/Organization

Connection to Parkinson's?

Listing as you would like it to appear in the digital program

Payment Option

I would like to add 3% to my donation to help MJFF offset the cost of credit card processing

Total: $

Please make checks payable to:
The Michael J. Fox Foundation (Tax ID #13-4141945) and mail to:

The Michael J. Fox Foundation
Grand Central Station
P.O. Box 4777
New York, NY 10163-4777

Payment Information

Name on Card

Billing Street Address

Billing City

State

Billing Zip/Postal Code

Card Type

Card Number

Credit Card Expiration Date

CVV Code

Player Information

Please provide the first and last name and email for each player as it's important we are able to communicate any information regarding this event to attendees.

By entering this information, you confirm that your guests have consented to you sharing their information with The Michael J. Fox Foundation.

Player First Name

Player Last Name

Player Email

Second Player Information

Player Two First Name

Player Two Last Name

Player Two Email

Third Player Information

Player Three First Name

Player Three Last Name

Player Three Email

Fourth Guest Information

Player Four First Name

Player Four Last Name

Player Four Email

Fifth Player Information

Player Five First Name

Player Five Last Name

Player Five Email

Sixth Player Information

Player Six First Name

Player Six Last Name

Player Six Email

Seventh Player Information

Player Seven First Name

Player Seven Last Name

Player Seven Email

Eighth Player Information

Player Eight First Name

Player Eight Last Name

Player Eight Email

Ninth Player Information

Player Nine First Name

Player Nine Last Name

Player Nine Email

Authnet_Hidden_Fields

Contact Information