North Capitol Collaborative

North Capitol Collaborative, Inc.

10^th Anniversary Gala

Friday October 17, 2008

Donation and Gala Ticket Purchase Form

Deadline:  Monday, October 6, 2008

___ I am unable to attend the North Capitol Collaborative Gala but would like to make a tax-deductible contribution in the following amount $ _________.

___ I would like to purchase _________ tickets to the North Capitol Collaborative Gala Event at

$55 ea.

____ Yes, I want to support NCCI as a 2008 Sponsor at one of the levels listed below:

Sponsorship Opportunities

___ Community  Benefactor - $2,000

 Table purchase (10 tickets) to Gala Dinner and full page Ad program book sponsorship

___ Platinum Sponsorship $1,000 - $1,999

 Six (6) ticket purchase to Gala Dinner and half page Ad program book sponsorship

___ Silver Sponsorship $250 - $999

 Two (2) tickets to Gala Dinner and half page Ad program book sponsorship

Name as you would like it to appear in Program Booklet: _____________________________________________________________________________________

Company Name: ________________________________________________________________________

Contact Name: _________________________________________________________________________

Address: ______________________________________________________________________________

City: _________________________________________ State: ____ Zip Code: _______________________

Phone: _________________ Facsimile: ________________ Contact Email: _________________________

Please Note - Receipt of all ticket purchase requests must be received by Monday, October 6^th, 2008

Payment Options (please address check payments to North Capitol Collaborative, Inc.):

___ Check ___ Money Order ___ Cash ___ Credit Card

Check / Money Order (Please make your check payable to):

North Capitol Collaborative, Inc.

Attn: Charon Ellis, Director of Finance

200 K Street NW, Suite #3

Washington, DC 20001

Credit Card Options:

___ Visa ___ MasterCard ___ American Express ___ PayPal

Card Number: ______________________________ Expiration Date: ____ / ____

Name on Card: ________________________ Signature: ____________________