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Foundation Ball Registration

Foundation Ball Registration

Reservations

Includes dinner, beverages, entertainment, and listing in program

* Payments in excess of $50 per person is tax deductible

Grand Patron - $150 *per person
Patron - $125 *per person
Sponsor - $100 *per person

Fair Market Value is $50 per guest.

Guests

Please enter your number of guests in the Reservations box above.

Please seat us with the following guests

Company or individual name as it should appear in the program.

Company Or Individual Name:

Billing address:

City:

State:

Zip Code:

Phone:

Fax:

Email:

* IRS regulations stipulate that registration fees are not tax deductible if there is the opportunity for you to win a prize that is worth more than the cost of the registration fee. Check with your tax advisor if you have any questions. Make checks payable to: The Wilson Memorial Hospital Foundation. Mail to Wilson Memorial Hospital, c/o Cashiers, 915 W Michigan St., Sidney OH 45365. Thank you.


Total: $