HNBA/VIA AC2021 In-Person Gala Request Form Deadline to Submit Request: Sunday, September 26, 2021 AC2021 Registration First Name:* AC2021 Registration Last Name:* AC2021 Registrant E-mail:* E-mail of Individual Completing This Form (if different from above, to receive copy of form submission):PLEASE CHOOSE ONE OF THE FOLLOWING REFUND OPTIONS:Option A: Pay It Forward - Donate to the HNBA VIA Law Student Scholarship FundOption B: Request a Full AC2021 Gala Fee Refund Select Option*Option A: Pay It ForwardOption B: Full Refund Please complete the subtraction math problem below before clicking submit.SubmitReset