Name
First Name
Last Name
Choose a Sponsorship Level
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Sponsor one patient for 1 event
$
50.00
Sponsor Tia’s Hope gift bag and gift card
$
100.00
Sponsor one patient and their family to an on premises event
$
250.00
Sponsor two patients and their families to an on premises event
$
500.00
Sponsor one patient and their family to an off premises event
$
1,000.00
Sponsor an on premises event for an entire hospital
$
5,000.00
Sponsor an off premises event for an entire hospital
$
10,000.00
Sponsor all events at a hospital for one year
$
25,000.00
Sponsor one year of Tia’s Hope bags and gift cards at one hospital
$
50,000.00
Sponsor and entire hospital for one year
$
75,000.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Email
*
example@example.com
Sponsor
Should be Empty: