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6TH ANNUAL FIESTA DE LOS NIÑOS
April 17, 2009
| __________ |
$25,000 MIRACLE SPONSOR |
| __________ |
$10,000 CHAMPION SPONSOR |
| __________ |
$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. |
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|
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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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