13th Annual Spring Gala
"Under The Big Top"

Saturday, April 20, 2013
Rochester Riverside Convention Center



Registration Form
Sponsors will be recognized with their name and/or company logo on the Unity Foundation web site, on a prominent sign displayed on their table(s), listed in the event program, and for the Title through Gold sponsors, on a banner displayed during the event.

 
Yes! I would like to be a gala sponsor at the following level:
Title $15,000 (4 tables of eight guests each)
Platinum $10,000 (3 tables of eight guests each)
Gold Plus $7,500 (2 tables of eight guest each,
plus an additional 4 seats in general seating)
Gold $5,000 (2 tables of eight guests each)
Silver $3,000 (1 tables of eight guests each,
plus an additional 4 seats – general seating)
Bronze $1,750 (1 table of eight guests)
Individual Sponsor $500 (2 tickets and program listing)
Individual Tickets $175 Quantity: 

The Unity Health System Foundation is a 501 (c) (3) charitable organization that raises philanthropic support for the Unity Health System.

* indicates required fields.

Total
Payment* Please send an invoice
I will mail a check m ade payable to Unity Health Foundation
Please charge my credit card
Card Type MasterCard   Visa   Discover   American Express
Credit Card #
Exp. Date
Name on Card
Security Code (Last 3 or 4 digits on back of card)
   
Company Name*
Contact Name*
Name as you would like to appear printed and on-line:*
 
Address*
 
City/State/Zip*
Phone*
Fax
Email*
Please indicate the number of vegetarian meals needed.
 
Names of Guests Enter up to 20 guest names separated by comma.