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2015 PEOPLE OF VISION AWARD DINNER
SPONSORSHIP FORM
Yes! I want to honor the outstanding leadership of Dr. Imran Andrabi/Mercy
and help in the fight against blindness by participating in the 2015 People of Vision Award Dinner from 5:30pm-8:00pm on March 31,
2015. The dinner will take place at
The Pinnacle, 1772 Indian Wood Circle Maumee, Ohio 43537.
___ Friends of the Honoree-Dr. Imran Andrabi and
Mercy -$5,000 (includes $4,600 donation)
Preferred table for 8 positioned adjacent to the Honoree/Host, signage, prominent program
recognition and PBO vision screening and education for sponsor organization employees or
clients (up to 3 consecutive hours)
___ Friends of the Host- Toledo-Lucas County
Health Department – $5,000 (includes $4,600
donation)
Preferred table for 8 positioned adjacent to the Honoree/Host, signage, prominent program
recognition and PBO vision screening and education for sponsor organization employees or
clients (up to 3 consecutive hours)
___ Reception Sponsor -$5,000
(includes $4,900 donation)
Prominent signage at reception, VIP seating for 2, prominent program recognition and PBO
vision screening and education for sponsor organization employees or clients (up to 3
consecutive hours)
___ Benefactor Sponsor -$3,500
(includes $3,100 donation)
VIP table for 8, prominent recognition and PBO vision screening and education for sponsor
organization or clients (up to 2 consecutive hours)
___ Patron Sponsor -$2,500
(includes $2,100 donation)
Table of 8, prominent recognition and eye health education for employees.
___ Corporate Table Sponsor -$1,750
(includes $1,350 donation)
Table for 8 and program recognition.
___ Individual Vision Sponsor -$750
(includes $650 donation)
Two seats and program recognition
___ Individual Seats -$250
(includes $200 donation)
___ Donation Amount $______ (100% tax-deductible)
CONTACT NAME:___________________________________ COMPANY NAME:_______________________________
TELEPHONE: (_____)______________________________
FAX:(_____)___________________________________
ADDRESS: _________________________________________________
CITY:__________________________________
STATE:________________ ZIP CODE:_______________ E-MAIL:____________________________________________
Checks should be made payable to Prevent Blindness. Send form to 2015 People of Vision Award Dinner; c/o Prevent Blindness; 2200 Jefferson Ave,
Suite 2020; Toledo Ohio 43604; Email: [email protected]; Fax: 419-327-2494; Phone: 419-327-2020.
All sponsorships at the $500 level and above will be listed on all publicity if this form is received before February 16, 2015.
NOTE: Tickets will not be sent. Receipt of your pledge or check assures your reservation. Business attire.