Cancer Wellness Center 2015 Annual Benefit

Reply Form

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* 1. Benefit Sponsorship Opportunities

$10,000 Wellness Benefactor - Table of 10 w/ Priority Seating and champagne service, Benefit Program Recognition, Gold accented full page message or ad in the Benefit Program.

$7,500 Giving Hand - Table of 10, Benefit Program Recognition, Silver accented full page message or ad in the Benefit Program.

$5,000 Mindful Partner - Table of 10, Benefit Program Recognition, Black accented full page message or ad in the Benefit Program.

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* 2. Benefit Program Ad/Message - Corrie Delevitt will contact you for Ad details. Print deadline is September 9th.

$2500 Silver Accented Full page

$1000 Black Accented Full Page

$500 Full Page

$250 Half Page

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* 3. Purchase a Table

I will purchase a table of ten (minimum $2000) or fill a table with ten friends ($200/person)

Please indicate names of guests here or contact Corrie Delevitt cdelevitt@cancerwellness.org by September 18th.

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* 4. Ticket Purchase

	Number of tickets
I would like to purchase a ticket/s at $200/person	I would like to purchase a ticket/s at $200/person Number of tickets menu
I am 30 years old or under and would like to purchase a ticket/s at $100/person	I am 30 years old or under and would like to purchase a ticket/s at $100/person Number of tickets menu

Please indicate names of guests here or contact Pam Anderson at panderson@cancerwellness.org by September 18th.

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* 5. I would like to buy Raffle Tickets - Tickets are $25 each or 5 for $100.

	Number of Tickets
Cirque Du Bling - Dazzling! Gorgeous! 18K white gold and diamond earrings. 2.35 carats. Valued at $6000. Courtesy of Cy Fredrics Jewelers.	Cirque Du Bling - Dazzling! Gorgeous! 18K white gold and diamond earrings. 2.35 carats. Valued at $6000. Courtesy of Cy Fredrics Jewelers. Number of Tickets menu
Cirque Du Sport -Calling all Chicago sports fans!4 lower deck box seats to a Chicago White Sox game,4 Lexus club level Black Hawks tickets,parking incl.,2 club level Chicago Bulls tickets with a parking pass,2 infield box seats to a Chicago Cubs game	Cirque Du Sport -Calling all Chicago sports fans!4 lower deck box seats to a Chicago White Sox game,4 Lexus club level Black Hawks tickets,parking incl.,2 club level Chicago Bulls tickets with a parking pass,2 infield box seats to a Chicago Cubs game Number of Tickets menu
Cirque Du Resort - Plan a fabulous getaway! Eight day/Seven night stay at your choice of a Hilton Grand Vacation Club Resort in Las Vegas or Orlando. Two bedroom Villa accomodations and treat yourself to a new outfit with a $1000 gift card to Ami Ami	Cirque Du Resort - Plan a fabulous getaway! Eight day/Seven night stay at your choice of a Hilton Grand Vacation Club Resort in Las Vegas or Orlando. Two bedroom Villa accomodations and treat yourself to a new outfit with a $1000 gift card to Ami Ami Number of Tickets menu
Cirque Du City-Enjoy a weekend at the Ritz Carlton Chicago and choose a delicious dining option with $500 in Lettuce Entertain You gift cards. Nothing to wear? Do some pre-shopping with gift cards; $500 at Ami Ami and $350 at Frances Heffernan!	Cirque Du City-Enjoy a weekend at the Ritz Carlton Chicago and choose a delicious dining option with $500 in Lettuce Entertain You gift cards. Nothing to wear? Do some pre-shopping with gift cards; $500 at Ami Ami and $350 at Frances Heffernan! Number of Tickets menu

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* 6. I would like to make a donation of...$_______

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* 7. Information

Name *

Company

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 8. Recognize me in all printed materials as:

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* 9. Total Amount:

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* 10. Credit Card Type

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* 11. Credit Card Information

Name on Credit Card

Card Number

Expiration Date

Security Code

All gifts are tax deductible less ticket couvert. Please contact Corrie Delevitt, cdelevitt@cancerwellness.org with any questions.