Dinner Dance Test Form DINNER-DANCE RESERVATIONSFirst Name *Last Name *Organization (optional)business or organization nameStreet AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeEmail Address *Phone Number (optional)Your Phone Number (optional)Individual TicketsNumber of TicketsNone | $0One | $100Two | $200Three | $300Four | $400Five | $500Six | $600Seven | $700Eight | $800Nine | $900Ten | $1000I wish to Donate Ticket(s) for Scholarship RecipientsNumber of TicketsNoneOneTwoThreeFourFiveSixSevenEightNineTenTables of 10Number of TablesNoneOne | $1000Two | $2000Three | $3000Four | $4000Five | $5000Six | $6000Seven | $7000Eigh | $8000Nine | $9000Ten | $10000What Name Should Table(s) Be Under?Please indicate personal or company nameVirtual Group TicketsUp to 20 attendees per Virtual GroupNoneOne | $500 - up to 20 viewers at one locationTwo | $1000 - up to 40 viewers at one locationThree | $1500 | up to 60 viewers at one locationVirtual Individual TicketsVirtual Individual TicketNoneOne | $50Two | $100Three | $150Four | $200Five | $250Six | $300Seven | $350Eight | $400Nine | $450Ten | $500I wish to contribute to the Scholarship FundSPONSORSHIPSCHOLARSHIPPremium Scholarship | $1500Scholarship | $1000PREMIUM SCHOLARSHIP - Ad on Purple Page, Scholarship Dedication, Commemorative Plaque SCHOLARSHIP - $1000 Gold Border Ad, Commemorative PlaqueADVERTISINGAD OPTIONS:AD: Back Cover | $1,000AD: Inside Cover ( only 1 avail.) | $750AD: Gold Border | $500AD: Silver Border | $300AD: Color | $200AD: B&W Ad - Full Page | $100AD: B&W Ad - Half Page | $50AD: Congrats (2-line, 10-character max.) | $25Ads are 5.5”w x 8.5”t w/1" border all sides (3.5"w x 6.5"t). Video/Photo Sponsor Color Ad. On-line and event recognition. | $1000Upload Ad, Logo, Photo or TextDrag and Drop (or) Choose FilesMost major file formats accepted (8MB limit).TOTAL DUE:$Send Message
