The Country Friends™


Sponsor Levels
Diamond	$450.00 each x	Total $
Gold	$250.00 each x	Total $
Gold w/ Lunch	$350.00 each x	Total $
Silver	$175.00 each x	Total $
Silver w/Lunch	$275.00 each x	Total $

List names as you wish them to appear in the Event Program:

Name(s):

Fashion Show and Lunch Ticket(s) - I wish to purchase tickets.
	@ $225.00 each - Total $
	Vegetarian Lunch list name(s)
Fashion Show Only Ticket(s) - I wish to purchase tickets.
	@ $125.00 each - Total $

Event Seating Request - I wish to be seated as follows:

At the Luncheon and/or Fashion Show with:

Name(s):

At a no host luncheon table

At a reserved luncheon table of 10 Guests:

1		6
2		7
3		8
4		9
5		10

All guest tickets will be held under their own name at check-in.
If sending individual checks, they all must accompany this reservation.
No reservations will be accepted without payment.

Opportunity Drawing

I wish to purchase tickets @ $5.00 each Total $

or Bundles of 6 tickets for $25.00

I wish to purchase bundles @ $25.00 each Total $

Donation

I am unable to attend, but wish to support the Burn Institute with a Donation.
All Donations of $100 or more will be listed in the event program.

Donation amount: $

Name(s) as you wish them to appear in the Event Program:

First and Last Name on Credit Card to be used:

Total Amount for the Event :

The tax deductible portion of your sponsor reservation is: Diamond($100) / Gold($50) / Silver ($25)

Sponsor Levels