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.

Would you like to sign up to receive e-mail news from Casa Esperanza?
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
		Full-page greeting inside cover of program book and company logo on front cover
		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 greeting in the program book
		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 greeting in the program book
		8 tickets to the event

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

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

		HOPE $2,500
		Listed as a Sponsor in the program book
		Half-page greeting in the program book
		2 tickets to the event

		Clear Selection

Table Sponsor
I would like to sponsor a table for community guests for $1000.

		Listed as a Sponsor in the program book
		Quarter-page greeting in the program book
		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 $75.

Program Greetings I would like to purchase a greeting in the “Action” Program Book.
$350 Full page 5”(w) x 8”(h)
$175 Half page 5” (w) x 3.78”(h)
$75 Quarter page (Business Card) 2.5” (w) x 3.78”(h)
Clear Selection

Attend the Event
I would like to reserve tickets to attend Casa Esperanza, Inc.’s Benefit Event.

No. of tickets		One Event Ticket includes breakfast, award ceremony and agency highlights for $75
No. of tables		One Table includes 10 Event Tickets for $650

Payment
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.