STEP 1) REGISTRATION FORM
Please make sure to enter your information accurately.

STEP 2) PAYMENT
You will be able to select U.S. Mail or On-line payment, and will be prompted once the registration form is complete.

Prefix
First Name
Middle Initial/Name
Last Name
Suffix
Degrees
Title
Prog/Org/Instit.
Address
Address
City/State/Zip
Phone
Phone
Fax
E-mail
		You will receive an e-mail confirmation at this address.

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Yes No


If you are listed as a sponsor in the program book, how would you like your listing to appear?
		Individual Name
		Program/Organization/Institution


Sponsorship
		NEW LIFE $25,000
		Listed as Lead Sponsor in the program book
		Company Logo will be prominently displayed on the front cover of program book
		Full-page ad in the inside cover of the program book
		Thanked on the invitation
		Mentioned as a Lead Sponsor in any press releases regarding the event

		20 tickets to the event (two tables)*
		*2 tickets from each table are donated to Casa Esperanza’s graduates

		WISDOM $15,000
		Listed as a Sponsor in the program book
		Full-page ad in the program book
		Thanked on the invitation
		Mentioned as a Sponsor in any press releases regarding the event

		10 tickets to the event (one table)*
		*2 tickets from each table are donated to Casa Esperanza’s clients

		GRATITUDE $10,000
		Listed as a Sponsor in the program book
		Full-page ad in the program book
		Thanked on the invitation
		8 tickets to the event

		COURAGE $7,500
		Listed as a Sponsor in the program book
		Full-page ad in the program book
		Thanked on the invitation
		6 tickets to the event

		SERENITY $5,000
		Listed as a Sponsor in the program book
		Half-page ad in the program book
		Thanked on the invitation
		4 tickets to the event

		HOPE $2,500
		Listed as a Sponsor in the program book
		Half-page ad in the program book
		Thanked on the invitation
		2 tickets to the event

		Clear Selection

Individual Ticket Sponsor
All Individual Ticket Sponsors will be listed in the program book.

No. of tickets		I would like to sponsor tickets for community guests who can not afford the ticket price of $125.

Program Greetings
$750 Full page 8”(w) x 5”(h)
$375 Half page 3.78”(w) x 5”(h)
$150 Quarter page (Business Card) 3.78”(w) x 2.5”(h)
$50 Listing
Clear Selection

Copy received after October 4, 2008 will only appear in the Program Insert.

Attend the Event
I would like to reserve tickets to attend Hope in Action 2008, Casa Esperanza, Inc.’s Annual Benefit Event.

No. of tickets		One Event Ticket includes dinner, program and dancing for $125
No. of tables		One Table includes 10 Event Tickets for $1,000

Payment
Payment deadline is October 23, 2008.
Mail (Check or Money Order)
On-Line (Credit Card or Bank Transfer Via PayPal). You do not need a PayPal account to select this option.

Notes/Other Instructions


	You will be asked to review your selections on the next page before your submission is complete.