Saint Luke Institute :: Annual Benefit Committee Response Form

I/We are pleased to join the Annual Benefit Committee at the following sponsorship level. Sponsors will be acknowledged in the program at the selected sponsor level and will receive the number of tickets noted: *

Leaders Circle: $100,000 - 10 tickets

Guarantor: $50,000 - 10 tickets

Underwriter: $25,000 - 10 tickets

Contributors: $10,000 - 8 tickets

Benefactor: $5,000 - 6 tickets

Sponsor: $3,000 - 5 tickets

Patron: $1,500 - 4 tickets

Friend: $750 - 2 tickets

Name(s): (as you would like it to appear on the Annual Benefit Invitation) *

Address: *

City: *

State: *

Zip: *

Daytime phone:

Evening phone:

Cell phone:

Email: *

Payment options: *

We will mail a check payable to Saint Luke Institute

We will call Saint Luke Institute with credit card information

We are pledging now and will fulfill this commitment by October 1, 2012

I/We are unable to join the Benefit Committee but would like to contribute to the healing ministry of Saint Luke Institute - we will mail a donation check

I/We are pleased to join the Annual Benefit Committee at the following sponsorship level. Sponsors will be acknowledged in the program at the selected sponsor level and will receive the number of tickets noted: *	Leaders Circle: $100,000 - 10 tickets Guarantor: $50,000 - 10 tickets Underwriter: $25,000 - 10 tickets Contributors: $10,000 - 8 tickets Benefactor: $5,000 - 6 tickets Sponsor: $3,000 - 5 tickets Patron: $1,500 - 4 tickets Friend: $750 - 2 tickets
Name(s): (as you would like it to appear on the Annual Benefit Invitation) *
Address: *
City: *
State: *
Zip: *
Daytime phone:
Evening phone:
Cell phone:
Email: *
Payment options: *	We will mail a check payable to Saint Luke Institute We will call Saint Luke Institute with credit card information We are pledging now and will fulfill this commitment by October 1, 2012 I/We are unable to join the Benefit Committee but would like to contribute to the healing ministry of Saint Luke Institute - we will mail a donation check