Child Safe Gala Sponsorship Registration Select your level of sponsorship Company or Individual Sponsor Name(Required)As it should appear in print.Select Sponsorship or Donate(Required)Please choose a level...Presenting $30,000Matching Gift $20,000Platinum $15,000Gold $10,000Activity $ 5,000Cocktail Table $2,500Make a DonationUpload Company Logo (Optional)Accepted file types: jpeg, png, Max. file size: 50 MB.Donation Amount Primary Contact(Required) First Last Primary Contact Email(Required) Enter Email Confirm Email Phone(Required)Ext.Phone Type(Required) Mobile/Cell Office Address(Required) Street Address (include suite or apt.#) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Secondary Contact Person(Required)Would you like us to work with a member of your staff on logistics (guest names, ads, etc.)? Yes No Secondary Contact Name First Last Secondary PhoneSecondary Email Total Donation Payment Method(Required)Please choose method...Check (An invoice will be emailed.)EFT, ACH, DAFs (Bank instructions will be emailed.)Credit Card - Pay NowDue to service fees, Check, EFT, ACH, DAF are preferred, but Credit Cards are welcomed. We appreciate your support. Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name
