2018 Tiffany's Tea Sponsor

Company Information:

Company Name:

Contact Name:*

PrefixFirst NameLast Name

Title:

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone:*

E-mail*

Confirmation Email

Payment Options: (Sponsor levels will show once the payment method is selected)

Payment must be received by January 22 to ensure inclusion in the event program and event signage.

Please select one:*

Please InvoiceCheck (payable to The Children's Healing Institute)Credit Card onlineCredit Card by phone

Please mail your check to: The Children's Healing Institute

2161 Palm Beach Lakes Blvd, Suite 212 | West Palm Beach, FL 33409

Please call 561.687.8115 to complete your credit card payment

Please note: Tiara (photographer) and Little Black Dress (champagne reception) sponsorships are sold out.

Please select your desired sponsorship level:

(Please note: Audrey Hepburn (Swag Bag) and Holly Golightly (Champagne) Sponsorships are sold out)

Event & Underwriting Sponsorships*

Tiffany - Presenting Sponsor $10,000Fifth Avenue - Tablescape Sponsor $8,500Blue Box - Mystery Box Sponsor $5,000Tiara - Photographer Sponsor - $1,500Little Black Dress - Cookie Sponsor $1,500

Event & Underwriting Sponsorships - not visible - Full list*

Tiffany - Presenting Sponsor $10,000Fifth Avenue - Tablescape Sponsor $8,500Blue Box - Mystery Box Sponsor $5,000Audrey Hepburn - Swag Bag Sponsor $3,500Holly Golightly - Champagne Sponsor - $2,500Tiara - Photographer Sponsor - $1,500Little Black Dress - Cookie Sponsor $1,500

I would like to sponsor a crib ($110) or make another donation

YesNo

Donation amount: *

I would like to purchase additional guest tickets

YesNo

# of GuestTickets:*

Total:

Event & Underwriting Sponsorships / Additional Guest Tickets*

Tiffany - Presenting Sponsor$10,000.00

Fifth Avenue - Tablescape Sponsor$8,500.00

Blue Box - Mystery Box Sponsor$5,000.00

Audrey Hepburn - Swag Bag Sponsor$3,500.00

Holly Golightly - Champagne Sponsor$2,500.00

Tiara - Photographer Sponsor$1,500.00

Little Black Dress - Cookie Sponsor$1,500.00

Additional Guest Tickets$150.00

Quantity

Crib Donation$110.00

Help us provide a safe space for a preemie baby to sleep and meet other vital care needs.

Total $0.00

Will the above named contact person be attending the event?*

YesNo

Guests: (included with sponsorship)

1. Name

PrefixFirst NameLast Name

1. Phone

1. E-mail

2. Name

PrefixFirst NameLast Name

2. Phone

2. E-mail

3. Name

PrefixFirst NameLast Name

3. Phone

3. E-mail

4. Name

PrefixFirst NameLast Name

4. Phone

4. E-mail

5. Name

PrefixFirst NameLast Name

5. Phone

5. E-mail

6. Name

PrefixFirst NameLast Name

6. Phone

6. E-mail

7. Name

PrefixFirst NameLast Name

7. Phone

7. E-mail

8. Name

PrefixFirst NameLast Name

8. Phone

8. E-mail

9. Name

PrefixFirst NameLast Name

9. Phone

9. E-mail

example@example.com

10. Name

PrefixFirst NameLast Name

10. Phone

10. E-mail

example@example.com

Additonal Guests:

1. Name

PrefixFirst NameLast Name

1. Phone

1. E-mail

2. Name

PrefixFirst NameLast Name

2. Phone

2. E-mail

3. Name

PrefixFirst NameLast Name

3. Phone

3. E-mail

4. Name

PrefixFirst NameLast Name

4. Phone

4. E-mail

5. Name

PrefixFirst NameLast Name

5. Phone

5. E-mail

6. Name

PrefixFirst NameLast Name

6. Phone

6. E-mail

7. Name

PrefixFirst NameLast Name

7. Phone

7. E-mail

8. Name

PrefixFirst NameLast Name

8. Phone

8. E-mail

9. Name

PrefixFirst NameLast Name

9. Phone

9. E-mail

10. Name

PrefixFirst NameLast Name

10. Phone

10. E-mail

Please list the name, phone, and email for each additional guest:

Media:

Upload Corporate logo (jpeg or png) for inclusion in event materials

Upload a File

Upload Company ad (jpeg or png) for inclusion in event materials

Upload a File

Full page ad: 5" x 8" (Tiffany Sponsor)

Half page ad: 5" x 4" (Fifth Avenue, Blue Box & Audrey Hepburn Sponsors)

Quarter page ad: 2.5" x 4" (Holly Golightly Sponsor)

In-kind donation

I would like to support the event with a gift-in-kind donation

Description:*

Value:*

Completion of this agreement form is confirmation of your support as a sponsor of the event, as set out above. Upon receipt of this form, The Children's Healing Institute will send an invoice for payment of the sponsorship amount if not included. Please note that sponsorships are non-refundable.