Complete Name (name tag) *

First Name

Last Name

Will you attend the Vision Brunch?

Yes, I/We plan to attend

No, I cannot attend, but I’d like to support CXI with a gift

Maybe / I’m not sure, please keep me updated

Mailing Address (optional)

Only if you’d like to update your address or receive CXI mailings (invitations, thank-you notes, updates).

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country