19th Annual Mariners Hospital 5K Walk/Run & 10K Run Saturday, November 19, 2022 Name: __________________________________________________________________________________________________ Company Name/ Contact Name: ________________________________________________________________________________ Mailing Address: ___________________________________________________________________________________________ City: ________________________________________ State: ________________ Zip: ____________________ Phone: __________________________ Email: __________________________________________________________________ For recognition purposes I would like my (our) name(s) to read as follows in Event Printed Materials: ________________________________________________________________________________________________________ I (We) wish to remain anonymous and elect not to be recognized. SPONSORSHIP $10,000 Marlin Presenting Sponsor
$1,000 Yellowfin Silver Sponsor
$5,000 Tarpon Platinum Sponsor
$500 Mahi Mahi Bronze Sponsor
$2,500 Dolphin Gold Sponsor UNDERWRITING ITEM: __________________________________________________________ Amount $ _______________ DONATION I cannot attend but would like to make a donation. Total Donation $ _______________ HONORARY TRIBUTE Honor or remember a friend, family member or loved one with a minimum of a $500 donation. Total Donation $ _______________ Gift in honor of In memory of Name: _________________________________________________________________________________ (Please print the honoree’s name as you would like to be recognized in the event program book) Please notify the following person of my tribute gift Name: ____________________________________________________________________________________ Address: ____________________________________________ City, State Zip____________________________ METHOD OF PAYMENT Please reserve my sponsorship as noted on the reservation form and send me an invoice. Quarterly The gift will be paid as follows: Payment in full Check made payable to Baptist Health South Florida Foundation Other: ______________________ To pay by credit card, visit: baptisthealth.net/giving
Monthly Amount $ ____________ CHECK#: ____________
Your signature below indicates you have reviewed and agree with the information you have provided on this form. Signature(s): ______________________________________________________ Date: ___________________ Donor information is strictly confidential and is never shared or sold to other organizations. Please consult your tax adviser for information on your donation. Non-tax deductible portion: $10 per person For more information contact Kelly Perez: Kelly.Perez@baptisthealth.net Baptist Health South Florida Foundation | 91500 Overseas Hwy. Tavernier, FL 33070 | 305-434-3120 A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE, 1-800-435-7352. OUR REGISTRATION NUMBER IS CH-10610. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE. THE FOUNDATION RETAINS 100% OF EACH CONTRIBUTION TO FULFILL OUR MISSION.
FOR INTERNAL USE ONLY | EVENT ID: ______ | FUND: ______ | MOVES MANAGER: ___________________ DONOR RE#: _______________ SOFT CREDIT:___________________ SOFT CREDIT RE#: ________________ | NAME OF PROPOSAL & RE#__________________________ SOLICITORS & RE#: ______________________________________________________________________________________________