Registration Details

I am purchasing sponsorships/tickets on behalf of:

First Name

Last Name

Company/Organization (If applicable)

Phone

Mailing Address

City

State

Postal Code

How would you like your name/your organization name listed in promotional materials?

Gala Selections

Donation Options

Underwriter Donation Package ($50,000): Two premier tables for ten at the Benefit; Prominent recognition as Underwriter in the Benefit Program, press releases and promotional materials; Invitation to a VIP recognition event; Treatment Scholarship in your name; Inside cover four color advertisement in the Gala Journal

Quantity

Benefactor Donation Package ($25,000): Premier table for ten at the Benefit; Recognition as a Benefactor in the Benefit Program, press releases, and promotional materials; Invitation to a VIP recognition event; Full page four color advertisement in the Gala Journal

Quantity

Sponsor Donation Package ($15,000): Preferred table for ten at the Benefit; Recognition as a Sponsor in the Benefit Program, press releases and promotional materials; Invitation to a VIP recognition event; Full page black & white advertisement in the Gala Journal

Quantity

Patron Donation Package ($10,000): Table for ten at the Benefit; Recognition as a Patron in the Benefit Program, press releases and promotional materials

Quantity

Donor Ticket ($2,500): Premier seating; Invitation to a VIP recognition event

Quantity

Supporter Ticket ($1,000)

Quantity

Friend Ticket ($600)

Quantity

Other $

Purchase Details

I would like to pay with my credit cardPlease contact me with more information about my selectionsPlease invoice me for my purchase

TOTAL AMOUNT

TAX ID: 13-39717403
The non-deductible portion for each table is $1,600.00
The non-deductible portion fo each ticket is $160.00

Payment Information

Name on Card

Card Number

Code

Billing Email

For more information, please contact:

Christine Madden

Event Office

(212) 725-7139

AISEventoffice@aol.com

Contact Information