Registration Details
I am purchasing sponsorships/tickets on behalf of:
Please select...
My Business/Organization
Myself (as an Individual)
First Name
Last Name
Company/Organization (If applicable)
Phone
Email
Mailing Address
City
State
Please select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
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Idaho
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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 card
Please contact me with more information about my selections
Please 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
MM
YY
Code
Billing Email
For more information, please contact:
Christine Madden
Event Office
(212) 725-7139
AISEventoffice@aol.com
Contact Information