Driscoll Children's Hospital

 6TH ANNUAL FIESTA DE LOS NIÑOS
April 17, 2009

__________

$25,000 MIRACLE SPONSOR

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$10,000 CHAMPION SPONSOR

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$5,000 PATRON SPONSOR

__________

$2,500 BENEFACTOR SPONSOR

__________

$1,800 TABLE SPONSOR

__________

$200 INDIVIDUAL TICKET (Non-Reserved Table)

__________

We are unable to participate at the sponsorship levels noted above, but would like to contribute
$___________ benefiting Fiesta de los Niños and Driscoll Children’s Hospital.

PRIMARY CONTACT INFORMATION:

____________________________________________________________________________________

Contact Name (please print)

____________________________________________________________________________________

Company/Organization Name (as you want it to appear on your table sign)

____________________________________________________________________________________

Address

________________________________________________

________

______________________

City State Zip Code

 

(______)______-__________

(______)______-__________

___________________________

Phone Number Fax Number Email

 

METHOD OF PAYMENT:

_____ MasterCard
_____ Visa
_____ American Express
_____ Discover

______________________________

_____/______

Account Number

Expiration Date

_____ Check Enclosed

_____Please bill me at address noted above.

 

 


Signature _______________________________________________ Date___________________________

PLEASE RETURN THIS FORM TO:

Development Foundation 3533 South Alameda Corpus Christi, Texas 78411
Fax this form to (361) 854-8279 or for more information, phone (361) 694-6401.

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