Registration Information
Friday November 5th, 2010 at 6:30p.m.
VENETIAN BANQUET CENTRE
219 Romina Drive, Vaughan, Ontario
HOW DO I GET MORE INFORMATION? GALA HOTLINE:416.410.2837 x 222 FAX APPLICATION: 416.410.2954 MAIL: Cheque payable to: The Joe DiPalma Foundation 641-1 Chrislea Rd. Vaughan, ON L4L 8A3
View PDF version of this Registration Form
Will Attend
Dinner
Donation Only
First Name
Last Name
Company
Address
City
Province
Postal Code
Country
Telephone
Fax
Email
Dinner Guest Names
CAN I HELP? I have merchandise to contribute to:
Silent Auction
Gift Bags
Contribution Items
Superstar Sponsor - $10,000
Prominent Recognition on Signage
Full Colour Page in Program
Three Full Dinner Tables -
24 gala dinner tickets
Rock Star Sponsor - $7,500
Prominent Recognition on Signage
Full Colour Page in Program
Two Full Dinner Tables -
16 gala dinner tickets
Entertainment Sponsor - $4,500
Full Colour Page in Program & Recognition on Signage 6 gala dinner tickets and seating with Ted & Marion Outerbridge
Star Sponsor - $2,500
Recognition on Signage
Half Coulour Prominent Page in Program
One Full Dinner Table -
10 gala dinner tickets
Raffle Trip Sponsor - $2,250
In Product or Monies
Half Colour Page in Program
4 gala dinner tickets
Friends & Family Tables $1,500
Quarter Page Greeting in Program
One Full Dinner Table -
8 gala dinner tickets
* Send logo and greeting to
ralph@ppgadvertising.com
Donations
(please select a donation ammount from the list below)
None
$20.00
$50.00
$100.00
$200.00
$300.00
$400.00
$500.00
$600.00
$700.00
$800.00
$900.00
$1000.00
$1100.00
$1200.00
$1300.00
$1400.00
$1500.00
$1600.00
$1700.00
$1800.00
$1900.00
$2000.00
$2100.00
$2200.00
$2300.00
$2400.00
$2500.00
$2600.00
$2700.00
$2800.00
$2900.00
$3000.00
$3100.00
$3200.00
$3300.00
$3400.00
$3500.00
$3600.00
$3700.00
$3800.00
$3900.00
$4000.00
$4100.00
$4200.00
$4300.00
$4400.00
$4500.00
$4600.00
$4700.00
$4800.00
$4900.00
$5000.00
Total $
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641-1 Chrislea Rd., Vaughan, On., L4L-8A3 – 416-410-1122
