Name:

Title:

Company:

Address:

City:

State:

Zip:

Phone:

Fax:

E-mail:

How did you hear about this event?

Corporate Sponsorships:
 

--Select a sponsorship level-- Gold Sponsorship ($10,000) Silver Sponsorship ($5,000) Bronze Sponsorship ($3,500) I'm not interested in a corporate sponsorship  

Table Sales (A table seats 10 people.): 
Please reserve
--Select the number of tables needed-- 1 Table for $1,000 2 Tables for $2,000 3 Tables for $3,000 4 Tables for $4,000 5 Tables for $5,000 I'm not interested in reserving a table
(The per table breakdown of cost is $250 for expenses, and $750 may be considered a charitable contribution.)
 

Individual Ticket Sales:
Please reserve
--Select the number of individual tickets needed-- 1 Ticket for $100 2 Tickets for $200 3 Tickets for $300 4 Tickets for $400 5 Tickets for $500 6 Tickets for $600 7 Tickets for $700 8 Tickets for $800 9 Tickets for $900 1 Ticket at the Purdue facutly/student/staff price 2 Tickets at the Purdue facutly/student/staff price I'm not interested in reserving individual tickets
(The per ticket breakdown of cost is $25 for expenses, and $75 that may be considered a charitable contribution.)
 

Guest names:
If you are buying more than one ticket, please indicate the name(s) of the guests. They are needed for table assignments.
Please add commas between names.

 

Comments:

 

The registration deadline is August 31, 2006.