Gala Ad Journal & Dinner Registration Form:

Your Name*

Your Email

Tel*

What is your message for the journal?

Which level ad are you purchasing?
Outside Back Cover - Includes Table of 10 - $15,000Inside Cover - Includes Table of 10 - $10,000Platinum Page - Includes Table of 8 - $5,000Table Page - Includes Table of 8 - $3,600Gold Page - Includes 2 dinner reservations - $1,800Silver Page - Includes 1 dinner reservation - $1,000Half Page - $500Business Card - $360Dinner Reservation - $225

How many dinner reservations are you making?

What are the names of the other people for whom you are making dinner reservations (if applicable)?

Do you require a vegetarian meal?