BLACK TIE AFFAIR

Sponsorship Selection

Please indicate the item and amount you wish to sponsor by placing the amount in the MY TOTAL column next to the item. If you are sponsoring more than one item, total your sponsorship dollars and enter the grand total in the field marked: TOTAL AMOUNT ENCLOSED.
Sign up for:	TotalCost
Title Sponsorship	$10,000 ___________________
Corporate Sponsorship	$5,000___________________
Platinum Sponsorship	$1,500 ___________________
Gold Sponsorship	$1,200___________________
Silver Sponsorship	$500 ___________________
Bronze Sponsorship	$200 ___________________
Team Sponsor	$380 ___________________
Individual Participation	$100___________________
¼ Page Ad	$100___________________
TOTAL AMOUNT ENCLOSED___________________

This form must be used and submitted with check.
Call for ad specs or goto website.

Name
_________________________________________________

Title
_________________________________________________

Company Name
_________________________________________________

Address
_________________________________________________

_________________________________________________

Phone
_________________________________________________

Fax Number
_________________________________________________

E-mail
_________________________________________________

Web-Site Address
_________________________________________

[Back]