RESPONSE FORM

RESPONSE FORM
Yes, I would like to become a NIGHT IN HOLLYWOOD Sponsor – Level of Sponsorship
Yes, I would like to become a NIGHT IN HOLLYWOOD Sponsor – Signature Sponsorship
Yes, kindly reserve        table(s) of 10 at $5,500 for a total of $
Yes, kindly reserve        Individual Seats for a total of $
Yes, kindly reserve        Full page ad(s) for a total of $
Yes, kindly reserve      Half page ad(s) for a total of $
GENERAL INFORMATION
Host Name
Company Name
e-mail Address*
Phone*
Address*
CREDIT CARD INFORMATION
Name on Card*
Card No.*
Security Code*
Expiration Date*
Card No.*

AmexVisaMastercard
Card Holder’s Authorized Signature

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