APRIL 11, 2015 REGISTRATION You may Register Online at www.GiveNorthEastFoundation.org Elite Sponsorship.......................$5,000 Prominent seating for 10, champagne service and upgraded wine selection, 10 raffle tickets Please direct my SPONSORSHIP toward the specialty area designated below. Choose only one. Premier Sponsorship...............$1,500 Preferred seating for 8 General Admission....................... $100 Table Assignments Please send me Due to limited space, seating will be assigned on a first-received basis. To be seated together, all names and payment for tickets must be included together in one envelope. Please print names of the persons to be seated at your table and include your own name(s). Gifts of Support offer an additional ticket(s). opportunity to support our Gala. Enclosed is _ my gift of $ . Please list my Sponsorship or Gift of Support in the Gala program book as: 1. 2. My check for $ Please charge my VISA Cabarrus College of Health Sciences Cancer Services Cardiac Services Emergency Services Endowment Greatest Need Jeff Gordon Children’s Hospital Neurosciences Surgical Services Women’s Services is enclosed. (payable to NorthEast Foundation) 3. 4. 5. Name on Card 6. DISCOVER AMEX Exp. / Signature Name 7. Address 8. City 9. eMail 10. Phone: Day registration deadline MC Card No. MARCH 27, 2015 ST Zip Evening Mail to NorthEast Foundation 920 Church Street North, Concord NC 28025 RAFFLE TICKETS Please mail To purchase your Raffle Tickets Online, visit www.GiveNorthEastFoundation.org raffle tickets at $25 each. My check for $ is enclosed. Please make checks payable to NorthEast Foundation. Please charge my credit/debit card. Visa MasterCard Discover American Express Card No. Exp. / Signature $7,000 Grand Prize Travel Voucher TRAVEL ANYWHERE YOU WISH! Name Address City ST Zip Create your own custom vacation package using a travel voucher valued at $7,000 or choose a $5,000 cash option. Tickets: $25 each eMail Phone: Day Or Buy 4 Get 1 FREE Evening NorthEast Foundation 920 Church Street North • Concord, NC 28025 • 704.403.1369 www.GiveNorthEastFoundation.org Need not be present to win. Drawing April 11, 2015 at the Annual Gala Special Thanks to Cabarrus Emergency Medicine Associates, PA for contributing the $7,000 Grand Prize Travel Voucher David A. Ahlers, MD / Bradley L. Anglemyer, MD / L. Charles Britton, MD / Scott R. Centers, MD / Robert C. Chen, MD / C. Craig Corey, MD / Stephanie R. Cox, MD Melora T. Driver, MD / Gerard E. Farris, MD / John D. Franklin, MD / Jeffrey M. Galvin, MD / Steve M. Gaskin, MD / Gregory L. Geers, MD / Jon L. Hobbs, DO Julie M. Howson, MD / Adam D. Langenbrunner, MD / Rusty J. Lee, MD / Mara L. Levitt, MD / William G. Masius, MD / Andrew L. Matthews, MD Douglas A. Miller, MD / G. Brent Mullis, MD / Earl J. Myers, MD / E. Rolland Phillips, MD / Keith A. Pochick, MD / Porshia M. Tomlin, MD In memory of John G. Sirois, MD