SPONSORSHIP & UNDERWRITING PLEDGE FORM
Sponsorship:
___ Title Sponsor - SOLD___ Swing Sponsor ....................................... $30,000___ Quick Step Sponsor .............................. $15,000 ___ Tango Sponsor ....................................... $10,000___ Salsa Sponsor .......................................... $ 5,000___ Cha Cha Sponsor ................................... $ 3,000___ Fox Trot Sponsor .................................... $ 1,500
Underwriting:
___ Dinner ....................................................... $20,000___ Ballroom Decor ..................................... $15,000 ___ Cocktail Reception ............................... $15,000
Entertainment. ....................................... $10,000Premium Wine ....................................... $10,000Floral.. ........................................................ $ 7,500Photography ........................................... $ 5,000
___ Valet Parking ........................................... $ 5,000___ Champagne ............................................ $ 2,500 ___ Bar .............................................................. $ 2,000___ Crystal Awards ........................................ $ 1,500
Ticket(s):
___ Table of Ten (non-sponsored) ............. $ 3,000___ Individual Ticket... .................................. $ 300
Program Ad Sponsorship:
___ Full-Page Program Ad ......................... $ 2,000___ Half-Page Program Ad ........................ $ 1,000___ Quarter Page Program Ad ................. $ 500
___ Donation .............................................. $ __ _
Total:$ __ _
MemorialCare Long Beach Medical Center is a community-based, non-profit hospital. Contributions made to MemorialCare
Long Beach Medical Center Foundation are tax-deductible to the fullest extent allowed by the law. IRC section 501(c)(3)
Tax ID #95-6105984.
Please print form legibly
Name: ________________ _
Preferred Recognition Name (for printed materials):
Address: _______________ _
Phone: _____ Email: _______ _
□ Payment enclosed by check payable to:Memorial Medical Center Foundation
□ Payment enclosed by credit card
Name on Credit Card: ____________ _
Billing Address: ______________ _
City: _______ State: ___ Zip: ____ _
Card Type: □ Visa □ MasterCard □ American ExpressCard#: _________________ _
Expiration Date: _________ CVV: ___ _
□ Please accept my pledge of$ _______ (To be paid by 3/14/20)
Confirm pledge commitment by signing below:
Signature: ___________ Date: ___
For stock donations, please contact the Events office at
562.933.1660 or [email protected]
•http:/ /bit.ly/iheartMHVI
Donations may also be made online
at: •
Please allocate my support to the following dancer(s):
__ Wayne Chaney Sr. __ Jan Rice __ Robert Senske, Jr. __ Marcelle Epley __ Sofia Riley
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