Innovator of the Industry Honoring Susan Whitaker Saturday, March 28, 2015 Donation Form I would like to honor Susan Whitaker with a Sponsorship Level of: ____ Gold Platter- $3,000* ____ Silver Platter- $1,500* ____ Bronze Platter- $750* ____ Wall of Fame- $50* ____ I am unable to participate as a sponsor, but please accept my donation of $__________. Tables and Tickets ____ I would like to purchase _____ seats x $150 each ____ I would like to purchase _____ tables x $ 1,000 each Contact Information Name:________________________________________________________________________________ Company:_____________________________________________________________________________ City, State, Zip; ________________________________________________________________________ Contact name: __________________________________ Tel: _________________________________ E-mail: _______________________________________________________________________________ Payment Information PAYING BY CHECK, please make check payable to University of Tennessee and mail to: Ann Fairhurst, Ph.D. 1215 Cumberland Ave, Room 110, University of Tennessee Knoxville, TN 37996-1911 PAYING BY CREDIT CARD, please fax this completed form to (865) 974-5236 or mail this form to the above address. Please charge my: MasterCard Visa Discover Card number: ____________________________________ Exp: ___________ Security Code: ________ Name on Card: _______________________________________________________________________ Signature: ___________________________________________________________________________ *Submission Guidelines Deadline: on or before February 25, 2015 Specifications  Acceptable file formats are .pdf (Acrobat 4.0 or later) with embedded fonts, or flattened/rasterized Photoshop .tif files. Files should be at least 300dpi at 100% scale.  Microsoft Word documents are not acceptable. Required Information  Contact name, name of your organization and your company’s logo (300 dpi).  Personal message (if applicable)  A digital (PDF) or hardcopy proof must be provided to e-mail or mailing address Please note that all submissions are subject to approval and final layouts are subject to change without notice. Send to Carol Costello at [email protected] or 865-566-8519. We will be happy to help you set-up your tribute to Susan Whitaker in the program.