Friday Nite with Chelsea White: Feb 26, 2016
A Scholarship Fundraiser for Students with Tourette Syndrome
Sponsorship & Donation Form
Sponsorship Levels
Silver Sponsor $100-$399_____ Gold $400 – $899_____ Platinum $900 and up_____
Includes 2 event tickets Includes 4 event tickets Includes 6 event tickets
Sponsor or Donor Information: (Please print clearly)
Name: __________________________________________________________________
Company (if applicable):____________________________________________________
Address:_________________________________________________________________
Phone:________________________ Email:____________________________________
Sponsorship amount if applicable: $___________________________________________
Raffle or Auction Donation/Item Information: (Please print clearly)*
Item/Service Donated:_____________________________________________________
Brief Description:_________________________________________________________
________________________________________________________________________
Restrictions (if applicable):__________________________________________________
Retail Value of Donation (Required): $_________________________________________
*Small donations for Goody Bags also accepted, Qty 100.
- Please return donation(s) with this form for each item to: Dollars 4 Tic Scholars, 21801 Little Bear Lane, Boca Raton, FL 33428. We can also pick up your donation, please call Kim at 561-756-2252.
- All sponsors and donors will be recognized on our website and in an insert in the event goody bags. We will use the information you provide under “Donor Information.” If you do not wish to be listed, please indicate it on this form.
- For questions or additional information, please contact Diane at 561-487-9526 or info@dollars4ticscholars.org.
- Deadline for donations is Friday February 19, 2016 for coordination and printing.
- All proceeds to Friday Nite with Chelsea White benefit Dollars 4 Tic Scholars, a non-profit 501c3 organization.
- Please note, all donations received past 2-19-15 will be listed and used for our next Foundation event.
- Sponsors and Raffle/Auction Item donors listed at https://www.dollars4ticscholars.org
___________________________________________________________________________________________________________
A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISON OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL OR RECOMMENDATION BY THE STATE. The toll-free number of the department is 1-800-HELP-FLA (435-7352) – calling from within the state of Florida, or (850) 410-3800 – calling from outside of Florida. Registration #CH41961.
THIS PAGE IS YOUR RECEIPT. PLEASE COPY OR PREPARE TWO, ONE FOR YOURSELF AND ONE FOR DOLLARS 4 TIC SCHOLARS. THANK YOU.