Sponsorship Form

2010 Reach for a Cure Wine Tasting

an evening supporting Friedreich’s Ataxia Research

Brought to you by the Muscular Dystrophy Association (MDA)

The Westin Atlanta Perimeter North

April 22, 2010

http://www.ReachforaCureFA.org

 

Personal or Company NAME: _________________________________________________________

 

CONTACT NAME (if different): ____________________________________________________

 

MAILING ADDRESS: ____________________________________________________________


____________________________________________________________ Zip: ___________

 

EMAIL: ____________________________________________________

 

PHONE: (_______) _______________________



_________________________________________________________________________



_____ Please register me / my company as a sponsor for this event.

_____ My check (made payable to MDA) will follow via mail.

_____ I will call the MDA office to pay by credit card (Visa, MasterCard, Discover or American Express)

 

_____ I won’t be able to attend, but please accept my donation of $_____________ to follow via mail.

 
 
Sponsorship Levels


 

___

 Presenting Sponsor

   $10,000

_____

 Vineyard Sponsor

   $5,000

_____

 Cabernet Sponsor

   $2,000

_____

 Chardonnay Sponsor

   $1,000

_____

 Zinfandel Sponsor

   $500

 

_____

 Individual Ticket

   $65

 

Make checks payable to MDA

120 Interstate North Parkway, Suite 448

Atlanta, GA 30339

Phone (770) 850-0533 Fax (770) 850-0733

MDA Tax ID #13-1665552

 

 

Committee Member Responsible:____________________



Rev: 09/24/09