Name*:
Emai*:
Organization:
Mailing Address:
City, State, Zip:
Phone or Fax: (with Area Code)
*indicates required field
Please indicate your level of sponsorship below.
CORPORATE SPONSORSHIP (view levels)
Diamond Corporate Patron - Table of Ten at $50,000 Emerald Corporate Patron - Table of Ten at $25,000 Ruby Corporate Patron - Table of Ten at $15,000 Sapphire Corporate Patron - Table of Ten at $10,000 Platinum Corporate Patron - Table of Ten at $7,500 Gold Corporate Patron - Table of Ten at $5,000 Silver Corporate Patron - Table of Ten at $3,500
INDIVIDUAL SPONSORSHIP
Individual Ticket(s) at $350 = (Total)
I/We are purchasing individual ticket(s) and would like to be seated with the following party/parties:
I wil not be able to attend, but I am making a tax-deductible donation of
Guest Names (check box if vegetarian entree is preferred)
Payment Options: I will mail in a check for by (date) I will donate online (see below) by (date)
1) Click 'Submit' to send your registration. 2) Then you may continue to Donate Online, OR 3) You may send your check, made payable to Alameda County Health Care Foundation, 1411 East 31st Street, Oakland, CA 94602.
Tickets will not be mailed; reservations will be held at the door. Fair market value of each ticket is $135.00. Any questions? Call (510) 535-7414.
ACHCF is a non-profit 501(c)(3) organization. Federal Tax ID #94-3103136.
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