GUEST INFORMATION  
  Names of those Attending
      
  Street Address  
   City  
  State  
  Zip  
 
  Total Attending Gala
 

Total Number Gala Tickets @ $125 person
 Attendees will be placed on the guest list for
entry at event registration table.
  Total Number Raffle Tickets @ $100 each
Trip for 2 to a Dallas Cowboys Football
Game 2012 at Texas Stadium, Dallas TX
  Phone
  E-mail (Required for electronic confirmation)
 SPONSORSHIP OPPORTUNITIES
  Purple Tie Sponsorship @ $750
(4) Gala Tickets and Name
Acknowledgement at Event
  Silver Tie Sponsorship @ $1500
(8) Gala Tickets, Reserved Table, and
Name Acknowledgement at Event
  Gold Tie Sponsorship @ $2250
(8) Gala Tickets, (8) Raffle Tickets,
Reserved Table, and Name
Acknowledgement at Event
 ADDITIONAL GIFTS
  Please accept an additional tax deductible
gift in the amount of . . .
 


Tickets and donations may be purchased by credit card or check.  
If you would prefer to submit your registration by MAIL
please print this page, complete form, and send to:
                        
Harrison Nichols Foundation
10516 Devonshire Drive
Huntersville, NC 28078

For secure credit card processing, please complete the information below.  An electronic receipt will be e-mailed as soon as the transaction is processed.
 
 CREDIT CARD INFORMATION
  Payment Type
  Full Name on Card
  Type of Card
  Credit Card Number
  Exp. (00/00)
  3-Digit CSC

 

 

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