G ALA
•
R A DA MS COWLEY
S H OC K T R AU MA C ENTER
SATURDAY, APRIL 25, 2015 / 6 PM – MIDNIGHT
BALTIMORE CONVENTION CENTER
SPONSORSHIP LEVELS
$ 150,0 0 0 HERO
$25 ,000 STA R
• Two tables of 10 for your guests
• One table of 10 for your guests
• Three tables of 10 that provide complimentary seating
for our Heroes: Shock Trauma staff, pre-hospital care
providers, police, firefighters, former patients
• Two tables of 10 that provide complimentary seating
for our Heroes: Shock Trauma staff, pre-hospital care
providers, police, firefighters, former patients
• Sponsor’s name will be prominently displayed
• Sponsor’s name will be prominently displayed
• Full-page ad in the Gala program
• Full-page ad in the Gala program
• Sponsor’s logo featured on the Shock Trauma Center website
• Sponsor’s logo featured on the Shock Trauma
Center website
• Podium recognition during the program
• Join Dr. Thomas Scalea on stage for partnership recognition
• Podium recognition during the program
• Exclusive invitation for eight guests to enjoy lunch and a private
tour of the Shock Trauma Center with Dr. Thomas Scalea
$15 ,000 G UA R D I A N
• One table of 10 for your guests
$ 10 0,000 CHAMP ION
• One table of 10 that provides complimentary seating
for our Heroes: Shock Trauma staff, pre-hospital care
providers, police, firefighters, former patients
• Two tables of 10 for your guests
• Three tables of 10 that provide complimentary seating
for our Heroes: Shock Trauma staff, pre-hospital care
providers, police, firefighters, former patients
• Sponsor’s name will be prominently displayed
• Half-page ad in the Gala program
• Sponsor’s name will be prominently displayed
$10,000 A L LY
• Full-page ad in the Gala program
• Sponsor’s logo featured on the Shock Trauma Center website
• One table of 10 for your guests
• Podium recognition during the program
• One table of 10 that provides complimentary seating
for our Heroes: Shock Trauma staff, pre-hospital care
providers, police, firefighters, former patients
$ 5 0,000 LEADER
• Sponsor’s name will be prominently displayed
• Two tables of 10 for your guests
$500 INDIVIDUAL TICKET
• Two tables of 10 that provide complimentary seating
for our Heroes: Shock Trauma staff, pre-hospital care
providers, police, firefighters, former patients
5
• Sponsor’s name will be prominently displayed
• Full-page ad in the Gala program
• Sponsor’s logo featured on the Shock Trauma Center website
• Podium recognition during the program
5
4
5
R A DA M S COW LE Y SHOCK TRAUMA CENTER GALA
SATUR DAY, A P RIL 25, 2015 / 6 PM – MIDNIGHT
B A LTI MO R E CONVENTION CENTER
Yes! We wish to support the Shock Trauma Gala.
‪ $15,000 Guardian
‪ $150,000 Hero
(tax deductible amount is $12,000; value of goods and services is $3,000)
(tax deductible amount is $142,000; value of goods and services is $8,000)
‪ $100,000 Champion
‪ $10,000 Ally
(tax-deductible amount = $7,000; value of goods and services = $3,000)
(tax-deductible amount = $92,500; value of goods and services = $7,500)
‪ $500 Individual Ticket
‪ $50,000 Leader
(tax deductible amount is $350; value of goods and services is $150)
(tax-deductible amount = $44,000; value of goods and services = $6,000)
‪ $25,000 Star
(tax-deductible amount = $20,500; value of goods and services = $4,500)
I would like to make an additional contribution of $
TITLE FIRST NAME
to support the R Adams Cowley Shock Trauma Center.
LAST NAME
SUFFIX
CITY ZIP
COMPANY NAME
ADDRESS STATE
HOME PHONE BUSINESS PHONEPREFERRED EMAIL
Payment Options:
‪ To make a contribution by check, please make check payable to Shock Trauma Gala
‪ Please charge $
to my: ‪ Visa
‪ MasterCard
‪ American Express
‪ Discover
NAME ON CREDIT CARD CREDIT CARD NUMBER
EXPIRATION DATE
3-DIGIT SVN CODE
‪ Business Credit Card
‪ Personal Credit Card
(on back of card)
If you are registering and paying by check, please mail this form and payment to:
Jenn VanLeuvan/Shock Trauma Gala
UMMS Foundation
110 S. Paca Street, 09-099
Baltimore, MD 21201
If registering with a credit card, please mail this form to the above address or fax to 410-328-5272.
Reservations will be held at the door. Tickets will not be mailed.
For further information regarding the Gala, please contact Jenn VanLeuvan at 410-328-6068 or [email protected].
Please indicate how you would like your name listed in the program: GUEST # 1 (TABLE CAPTAIN)
GUEST #6
GUEST #2GUEST #7
GUEST #3GUEST #8
GUEST #4GUEST #9
GUEST #5GUEST #10
The UMMS Foundation, Inc. is a 501(c)(3) nonprofit organization, serving as the fund-raising entity for the R Adams Cowley Shock Trauma Center - donations to which are tax deductible to the fullest extent allowed
by law. A copy of our current financial statement is available upon request by contacting the UMMS Foundation, Inc. at 110 South Paca Street, 9th floor, Baltimore, MD 21201, or by calling 410-328-5770. Documents
and information submitted to the State of Maryland under the Maryland Charitable Solicitations Act are available from the Office of the Secretary of State for the cost of copying and postage.
15-E07-STG