Northside 2008 Annual Gala

Registration Form
(All fields are required)
Name:
City:
Zip:
Phone:
 Fax:
Email:
 Click here if this is also your billing address
Please indicate how you wish to be listed on printed material:
Please reserve the following for the Northside Center Gala:
at $25,000 Qty:
Patron Table(s) at $15,00 Qty:
Sponsor Table(s) at $10,000 Qty:
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Benefactor Ticket(s) at $2,500 Qty:
Patron Ticket(s) at $1,500 Qty:
Sponsor Ticket(s) at $1,000 Qty:
Young Patron Ticket(s) at $300 Qty:
Tables at the Gala seat ten
For tax purposes, the non-deductible portion of each ticket is $175


Name of Guests: (Please seperate names by comma)

I am unable to attend the event but wish to make a tax-deductible contrubution to the Northside Center
please put your amount to this box:

Please enter your credit card information:
(All fields are required)
Card Number
Exp. Date
   
Billing Address:
City:
State:
Zip Code:
Daytime Phone:
Email:

 

 

 

 

 

 

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