Deadline: Feb. 20, 2013
Brain Injury Association of America
Grand Prairie • Sugar Land • Round Rock • San Antonio
Sponsorship Form 1. 2. 3. 4.
Select the Walk for Brain injury location(s) you wish to sponsor Mail: BIAA – Texas Division, P.O. Box 95234, Grapevine, TX 76099-9752 Make checks payable to Brain Injury Association of America – Texas Division (Tax ID 4-2716222) BIAA – Texas Division will e-mail you a receipt.
Round Rock (Metro Austin) March 9 Grand Prairie (DFW) March 23 Sugar Land (Metro Houston) March 16 San Antonio Fall
Your contact information Select One: q Mr. q Mrs. q Ms. q Mr. and Mrs. q Dr. q Other Name Company Street Address City, State, ZIP Country E-mail Phone Special Instructions Signature Benefits for various levels detailed on SPONSOR BENEFITS PAGE q $ 1,500 1 or more single site(s) q $35,000 All Walk sites statewide q $ 500 Commercial exhibitor per site q $10,000 1 or more selected site(s) q $ 150 Nonprofit exhibitor per site q $ 3,500 1 or more single site(s) Check enclosed for $
q $ 250 Logo on video board, path signs q IN-KIND (See In-Kind form on reverse) q OTHER $
Date ________________
PREFER TO PAY SPONSORSHIP BY CREDIT CARD? To pay by credit card, please visit www.biausa.org and select the green Donate and Support button on the left side. To comply with PCI regulations which
have been designed by the credit card industry to reduce the potential that your credit card data will be stolen, credit card donations must be made through our secure website at www.biausa.org. MasterCard, VISA, Discover and American Express are accepted.
Contact name and e-mail for benefit details / logo: Please send your organization’s logo in jpg format to Bill Roof, Director, BIAA – Texas Division, at wroof@biausa.org no later than Jan. 23, 2013, to ensure inclusion in Walk brochure. Questions: 512-944-3566 or 703-761-0750 X:644
Brain Injury Association of America
Grand Prairie • Sugar Land • Round Rock • San Antonio
In-Kind Donation Thank you for your in-kind donation for the Texas Walk for Brain Injury at the location(s) checked below. This form will help us properly record and acknowledge your generous gift. If you have any questions, please contact Bill Roof, Director, BIAA – Texas Division at wroof@biausa.org or 512-944-3566 or 703-761-0750 X:644 Please select the location(s) for your in-kind donation
Round Rock (Metro Austin) March 9 Grand Prairie (DFW) March 23 Sugar Land (Metro Houston) March 16 San Antonio Fall
Donation and Donor Information I/we wish to donate the items listed for the location(s) selected.
Estimated Value of Donation $___________________ Date of Donation ___________________ Select One: q Mr. q Mrs. q Ms. q Mr. and Mrs. q Dr. Name Company Street Address City, State, ZIP Country E-mail Phone Special Instructions Signature
q Other
Please send this form to BIAA – Texas Division, A Walk for Brain Injury volunteer will contact you regarding donation arrangements. Email
wroof@biausa.org
FAX
703-761-0755
Bill Roof BIAA – Texas Division PO Box 95234 Grapevine, TX 76099-9752
Thank you again for your generous gift. Together we are making a difference for individuals with brain injuries in Texas.
The Internal Revenue Service (IRS) requires, for our records and yours, that an estimation of the dollar amount of a non-cash contribution be given. The estimation must be made by the donor. IRS publication 563, Determining the Value of Donated Property is helpful for individuals, partnerships and corporations which make non-cash contributions. If a non-cash contribution exceeds $5,000, the taxpayer must file IRS form 8283.