registration form - Respite Care of San Antonio

Respite Care of San Antonio’s
28th Anniversary Luncheon
Tuesday, November 3, 2015
11:30 a.m.
at the Historic Pearl Stable
SPONSORSHIP LEVELS
2015-2016
Board of Directors
Brian Biggs
Carol Carr
Sandi Cavazos
David Darr
Tom Dobson
Jessica Drought
LaVerne Dysart
Kelly Fellbaum
Jamie Fox
Barbara Gentry
Cortney Gill
Charles Gonzalez
Lacie Gorder
Alyssa Hartlage
Jennifer Johnson
Lori Johnson
Cindy Jorgensen
Bekki Kowalski
Michael Kuhn
Donnie Laurence
Neal Leonard
Kim Lewis
Bill Mason
Steve Phillips
Kimberley Rash
Jacqueline Roberts
Carson Rubey
Louie Rubiola
Lou Simmons
Marilyn Taylor
Bill Triplett
Lauren Ashley Valkenaar
Sharon Wilson
Keith Winn
Jay Winslow
Stacey Woods
Steve York
Bert Pfiester, CEO
Cara Magrane, COO
All sponsorship levels include a table for 10 and
a special visit from a Respite Care child during dessert who will
present the table sponsor with a commemorative work of original art!
$10,000 Presenting Sponsor
$5,000 Gold Sponsor
$2,500 Silver Sponsorship
$175 Individual Ticket per person
$______ I am unable to attend but wish to make this
donation for the children of Respite Care.
First Name: _______________________ Last Name: ____________________________________
Prefix:
Mr./Mrs./Miss/Ms./Dr./Other _____________ Suffix: Jr./Sr./III/Other ___________
Street Address: ___________________________________________Apt/#:__________________
City:________________________________ State: _______________ Zip: __________________
Organization (If Applicable): _________________________________________________________
Name To Be Listed In Program: _______________________________________________________
RSVP & RESERVE
YOUR PLACE
BY WEDNESDAY,
OCTOBER 28
FAX this completed form to (210) 736-5940; OR
SCAN & EMAIL this completed form to [email protected]; OR
MAIL this completed form to P.O. Box 12633, San Antonio, TX 78212; OR
ONLINE registration is available at www.respitecaresa.org
Visit our website to download a digital copy of this form.
Enclosed is my check, payable to Respite Care of San Antonio.
VISA
MASTERCARD
AMEX
NAME ON CARD: ________________________________________________
ACCOUNT #: ___________________________________________________
BILLING ZIP CODE: ____________________ EXP. DATE _______________
PHONE NUMBER: ________________________________________________
SIGNATURE: ____________________________________________________
Questions? Contact Bert Pfiester or Cara Magrane at 210-737-1212.
Thank you for your support of the children of Respite Care!