Making a Difference: A Gala in Celebration of Women of Excellence

Dinner Reservations

Please reserve the following:

DIAMOND TABLE(S) at $15,000
Includes premier seating and the inside cover in the journal. (Only 3 available).

PLATINUM TABLE(S) at $7,500
Includes premier seating and a platinum page in the journal.

GOLD TABLE(S) at $6,000
Includes premier seating and a double gold page in the journal.

SILVER TABLE(S) at $5,000
Includes premier seating and a silver page in the journal.

SPONSOR TICKET(S) at $500
Includes premier seating.

DONOR TICKET(S) at $350

I am unable to attend but enclosed is my contribution of $
In honor of

MY GUESTS WILL BE:


PLEASE SEAT ME WITH:


 

Space Reservation For Journal

Back Cover | $10,000
Inside Front Cover | $7,500
Inside Back Cover | $5,000
Platinum Page | $3,500
Gold Page | $2,500
Silver Page | $1,500
Bronze Page | $1,000
White Page | $500

  Please indicate your tribute below:
 
My ad is in honor of
 
Title
Last Name
First Name
Company Name
Address
Address 2
City
State
Zip
Phone
--
Email Address
 
Credit Card Number
Credit Card Expiration
/
Name On Card
CVV Security Code
 
 

R.S.V.P. and Journal Deadline: April 9, 2012
Your contribution less $150 per seat is tax-deductible.
For further information, please call (212) 629-9770 or fax to (212) 629-5652 or info@kidneyurology.org.

 

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Kidney & Urology Foundation of America
2 West 47th Street, Suite 401, New York NY 10036
Copyright 2012