HARD WORKING PARENTS WITH CHILDREN PROGRAMSPONSOR SIGN UP AND PAYMENT

Full Name *

First Name Last Name

Company Name

Phone Number *

Area Code Phone Number

Email *

example@example.com

Mailing Address for Thank You Package *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Sponsorship Package *

BRONZE $50.00 SILVER $100.00 GOLD $250.00 PLATINUM $500.00 DIAMOND $1,000.00

We sincerely thank you from all the families that have and will be helped through the Hard Working Parents with Children Program. Sponsors will receive tickets to our motivational speaking events via Email with preferred seating.

Do you have any food allergies? *

YES NO

If yes, please list. *

IF NONE, SIMPLY TYPE N/A

Sponsorship Payment *

DIAMOND Sponsorship $ 1,000.00

Quantity

PLATINUM Sponsorship $ 500.00

Quantity

Gold Sponsorship $ 250.00

Quantity

Silver Sponsorship $ 100.00

Quantity

Bronze Sponsorship $ 50.00

Quantity

HWPC T-SHIRT $ 20.00

ALL T-shirt proceeds go directly to our Hard Working Parents with Children Program

T-Shirt T-Shirt Quantity
Item subtotal: $ 0.00

HWPC TUMBLER $ 20.00

ALL Tumbler Purchase Proceeds go directly to our Hard Working Parents with Children Program. 1 Tumbler + 1 T-Shirt Purchase = 1 Family Dinner.

Quantity
Item subtotal: $ 0.00

Subtotal $ 0.00 Tax $ 0.00 Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Recurring Monthly? *

Yes No

Signature *

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