TABLES, TICKETS & UNDERWRITING FORM Please select one of the following: TABLES ___ Platinum Table - $10,000
___ Gold Table - $5,000
(Includes 10 guests per table, a Platinum Journal Page and Premier Seating)
(Includes 10 guests per table, a Gold Journal Page & Premier Seating)
___ Silver Table - $2,500
___ Table - $2,000
(Includes 10 guests per table, a Silver Journal Page & Premier Seating)
(Includes 10 guests per table)
TICKETS ___ Platinum Benefactor Tickets - $1,000 each
___ Benefactor Tickets - $500 each
(Includes special mention in Journal & Premier Seating)
(Includes special mention in Journal & Elite Seating)
___ Patron Tickets - $250 each
___ Friend Tickets - $200 each
(Includes special mention in Journal)
UNDERWRITING (All underwriters will be recognized in print and online media.)
___ Event Underwriting - $20,000 ___ Cocktail Reception Underwriting - $5,000
___ Diner Underwriting - $10,000 ___ Decorations Underwriting - $3,000
CHECKOUT First & Last Name of Individual __________________________________________________ Address _____________________________________________________________________ City ___________________________ State _____________ Zip Code ___________________ Email ___________________________________________ Phone ______________________
PAYMENT INFORMATION Enclosed is a check in the amount of $___________ or Please charge my/our credit card in the amount of $ ____________ Circle one: a) Amex b) Discover c) MasterCard d) Visa Name on Card _________________________________________________ Credit Card # __________________________________________________ Authorized Signature ___________________________________Expiration Date ____________ Security Code ___________
Please send your completed form and payment to: Attn: Kate Fiscus • Loyola School • 980 Park Avenue • New York, NY 10028 Email: kfiscus@loyola-nyc.org • Office Phone: 646.346.8135
Loyola School thanks you for your support!