PARTICIPATION FORM

COMPANY/SPONSOR NAME*

First NameLast Name

CONTACT NAME & POSITION*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Who reached out to you for the Sponsorship Packet?:*

Please write how you would like your name to be listed for sponsor/donor recognition:*

PLEASE SELECT YOUR LEVEL OF SPONSORSHIP*

DIAMOND $6,000 (10 tickets*)RUBY $3,000 (8 tickets*)SAPPHIRE $2,000 (6 tickets*)EMERALD $1,000 (4 tickets*)OPAL $500 (2 tickets*)Other — Monetary donations under Sponsorship Levels will be acknowledged by name in the Event Program.

*NOTE: If you will be attending, please list the names of event attendees below. If you will NOT be attending and want to be a sponsor only, please select the appropriate box below.

Attending Sponsor - EVENT ATTENDEE NAMES:
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name
First Name   Last Name

Non-Attending Sponsor (please donate our tickets)

MONETARY DONOR-SPONSOR - I am unable to attend.

Please accept this donation of $ Number.

PAYMENT OPTIONS*

Check payable to In Jerry's Footsteps. Mail to: In Jerry's Footsteps, P.O. Box 519, Green, Ohio 44232Remit Payment online here:

In Jerry's Footsteps Sponsorship/Donor Payment:

USDDescription

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay