2008 Harvest Ball Commitment Form
In
support of Stillwaters Cancer Support Services (tax #39-1818956) many programs
and services, we pledge our support to the 2008 Harvest Ball.
Company/organization:___________________________________________________________
Contact Name:
_________________________ Contact email: ____________________________
Address: _______________________________________________________________________
City/State/Zip:
___________________________________________________________________
Phone:
____________________ Fax:
_________________________
Please accept our commitment
for the:
________ Gold - $5,000 (return by 8/17/08)
________ Silver - $3,000 (return by 9/3/08)
________ Bronze - $2,000 (return by 9/3/08)
________ Contributor - $1,000 (return 9/3/08)
________ NEW! Sponsor a Survivor to attend Harvest Ball - $200
________ In Honor/In Memory - $100 (return by 10/1/08)
No, I am not able to attend,
please accept this donation in support of your programs and services $___________
Name of Individual for the
In Honor/In Memory of designation: _______________________________________
Enclosed is a check payable to Stillwaters Center in the amount
of $__________________
Please invoice me for payment in the amount of $_____________________
Please charge my
credit card for $_________________ Visa ___ Master Card ___
Card
#:_____________________________________________________ Exp.
Date:_______________
Date_________
______________________________________________________________________
(Signature)
______________________________________________________________________
(Print Name)
Please return this pledge form
to: Stillwaters Center Inc.
434 Madison Street,
Waukesha, WI 53188
Phone (262)
524-4138 Fax (262)
513-5731
Thank
you for your support of Stillwaters Cancer Support Services.