Includes program, media and banner promotion, does not include any attendees
None Beverages - $5,000 Orchestra - $2,200 Stationery - $750
Includes dinner, beverages, entertainment, and listing in program
_____ Grand Patron - $150 *per person _____ Patron - $125 *per person _____ Sponsor - $100 *per person
Fair Market Value is $50 per guest.
Company Or Individual Name:
Billing address:
City:
State:
Zip Code:
Phone:
Fax:
Email:
Guest #
Name
Meal Choice
Guest 1
Guest 2
Guest 3
Guest 4
Payment to follow
* 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.
