LEADERSHIP Response Form
Your response must be received by January 31, 2017 in order for you to be listed on the invitation.
TABLES
____ Chairman’s Circle: $20,000
____
(Includes premium table of ten, champagne with
dessert, recognition on invitation and program, and
invitation for two to the March 28th cocktail
reception hosted by Anne and Tom Hubbard and
Helen and DuWayne Sayles at The Brook Club)
____
(Includes dinner for one at premium table,
recognition on invitation and in program, and
invitation for one to the March 28th cocktail
reception hosted by Anne and Tom Hubbard and
Helen and DuWayne Sayles at The Brook Club)
President’s Circle: $15,000
____
(Includes prime table of ten, champagne with dessert,
recognition on invitation and program, and invitation
for two to the March 28th cocktail reception hosted
by Anne and Tom Hubbard and Helen and DuWayne
Sayles at The Brook Club)
____
____
INDIVIDUALS
Underwriter: $2,500
____
____
Director’s Circle: $10,000
(Includes priority table of ten, recognition on
invitation and program, and an invitation for two to
the March 28th cocktail reception hosted by Anne
and Tom Hubbard and Helen and DuWayne Sayles at
The Brook Club)
Junior’s Circle (ages 35 and under): $3,500
(Includes table of ten, and recognition on invitation
and program)
____
____
____
_____
Benefactor: $1,500
(Includes dinner for one at prime table and
recognition on invitation and in program)
Sponsor: $1,000 (Includes dinner for one and
recognition on invitation and in program)
Friend: $600 (Includes dinner for one and
recognition in program)
Dinner Ticket: $500 (Includes dinner for one)
Junior Ticket (ages 35 and under): $400
(Includes dinner for one)
Please seat me at a Junior Table (ages 35
and under)
Dancing Only: $140 (Includes practice, dancing
and drinks, 9:00 - midnight)
____
I/We would like to make a contribution. Although I/we cannot attend, I/we would like to make a tax-deductible
contribution of $______________. Contributions of $600 or more will be included in appropriate listing on the invitation
and/or in the program.
PAYMENT
____ Enclosed is my check, made payable to The National Trust for Scotland Foundation USA, in the amount
of $____________ for tickets as indicated above.
____ Please charge my credit card in the amount of $__________ for tickets as indicated above.
Credit Card (circle one):
American Express
Visa
MasterCard
Discover
Credit Card No.: ______________________________ Expiration Date: ____________ Security Code:_____
Name as it appears on card: ______________________________Signature: ____________________________
____________________________________________________________________________________________________________
My/Our Names (AS THEY SHOULD APPEAR ON PRINTED MATERIALS)
____________________________________________________________________________________________________________
Address
_____________________________________________________________________________
City/State/Zip
Email Address
____________________________________________________________________________________________________________
Daytime Telephone
Evening Telephone
Fax Number
PLEASE NOTE: All but $205 per person is tax-deductible according to applicable Federal tax law.
The National Trust for Scotland Foundation USA, Inc. is a 501(c)(3) corporation registered in the Commonwealth of Massachusetts. Federal Tax ID No. 04-3511088.
Please return this form to the address below by post, fax (617-227-4200), or email ([email protected])
The National Trust for Scotland Foundation USA, 45 School Street, 3rd Floor, Boston, Massachusetts 02108