Virtua Gala 2019

UNDERWRITING, ADVERTISING & PARTICIPATION ORDER FORM Reservations or advertisements will be processed when a signed form or payment is received. CONTACT INFORMATION Sponsoring Organization or Individual (The sponsorship will be recognized using this name in printed materials, announcements, etc.) Sponsor name ______________________________________________________________________________________ Contact person ________________________________Title _________________________________________________ Phone _____________________________ Fax __________________________ Email ____________________________ Billing address ______________________________________________________________________________________ City _______________________________________________ State_______________ Zip Code ___________________ EVENT PARTICIPATION Sponsorship/Underwriting m Platinum Studio Sponsor - $35,000 m Gold Sponsor - $25,000 m Silver Sponsor - $15,000 m Bronze Sponsor - $10,000 m Copper Sponsor - $7,500 m STAR Sponsor - $5,000 m Celebration Sponsor - $2,500 m Friend of Virtua - $1,000 m Individual Ticket - $450 m 50/50 Ticket - $100 each (NJLGCC ID#137436187 / Municipal RL#4444) CONTRIBUTION Sponsorship Total ........................................................................... $__________ Ticket Total ..................... ______ Tickets @ $450 each .................. $__________ Program Book Ad ........................................................................... $__________ 50/50 Tickets ................... ______ Tickets @ $100 each ................. $_________ Total Commitment .......................................................................... $__________ (Cancellations made within 72 hours of the event will not be subject to a refund.) Payment Method: m Check enclosed made payable to Virtua Foundation m Credit Card m Please bill us FOR CREDIT CARD PAYMENT (Circle card type) American Express MasterCard Visa Discover Card Number _________________________________________ Expiration Date _____________CSV Code _______ Name on Card ___________________________________________ Signature ________________________________ AUTHORIZATION I agree to the above support of Virtua Foundation through the 2019 Gala (Signature or payment is required to process your commitment.) Print Name _______________________________________________ Signature _______________________________ Phone: 856-355-0830 Email: VHF@virtua.org Fax: 856-355-0831 # Additional Advertising Options m Double-page (16”w x 8”h) four-color ad - $4,000 m Full-page (8”w x 8”h) four-color ad - $3,000 m Half-page (8”w x 3.875”h) four-color ad - $2,500 m Full-page (8”w x 8”h) b&w ad - $2,000 m Half-page (8”w x 3.875”h) b&w ad - $1,500 m Quarter-page (3.875”w x 3.875”h) b&w ad - $750 m Eighth-page (3.875” w x 1.8125”h) b&w ad - $500 m Contributor (listing) $300 Mail: Virtua Foundation P.O. Box 70260 Philadelphia, PA 19176-9703 REGISTRATION OPTIONS Web: Foundation.Virtua.org