SPONSORSHIP & UNDERWRITING PLEDGE FORM

Sponsorship:

___ Title Sponsor - SOLD___ Swing Sponsor ....................................... $30,000___ Quick Step Sponsor .............................. $15,000 ___ Tango Sponsor ....................................... $10,000___ Salsa Sponsor .......................................... $ 5,000___ Cha Cha Sponsor ................................... $ 3,000___ Fox Trot Sponsor .................................... $ 1,500

Underwriting:

___ Dinner ....................................................... $20,000___ Ballroom Decor ..................................... $15,000 ___ Cocktail Reception ............................... $15,000

Entertainment. ....................................... $10,000Premium Wine ....................................... $10,000Floral.. ........................................................ $ 7,500Photography ........................................... $ 5,000

___ Valet Parking ........................................... $ 5,000___ Champagne ............................................ $ 2,500 ___ Bar .............................................................. $ 2,000___ Crystal Awards ........................................ $ 1,500

Ticket(s):

___ Table of Ten (non-sponsored) ............. $ 3,000___ Individual Ticket... .................................. $ 300

Program Ad Sponsorship:

___ Full-Page Program Ad ......................... $ 2,000___ Half-Page Program Ad ........................ $ 1,000___ Quarter Page Program Ad ................. $ 500

___ Donation .............................................. $ __ _

Total:$ __ _

MemorialCare Long Beach Medical Center is a community-based, non-profit hospital. Contributions made to MemorialCare

Long Beach Medical Center Foundation are tax-deductible to the fullest extent allowed by the law. IRC section 501(c)(3)

Tax ID #95-6105984.

Please print form legibly

Name: ________________ _

Preferred Recognition Name (for printed materials):

Address: _______________ _

Phone: _____ Email: _______ _

□ Payment enclosed by check payable to:Memorial Medical Center Foundation

□ Payment enclosed by credit card

Name on Credit Card: ____________ _

Billing Address: ______________ _

City: _______ State: ___ Zip: ____ _

Card Type: □ Visa □ MasterCard □ American ExpressCard#: _________________ _

Expiration Date: _________ CVV: ___ _

□ Please accept my pledge of$ _______ (To be paid by 3/14/20)

Confirm pledge commitment by signing below:

Signature: ___________ Date: ___

For stock donations, please contact the Events office at

562.933.1660 or EventsMMCF@memorialcare.org

•http:/ /bit.ly/iheartMHVI

Donations may also be made online

at: •

Please allocate my support to the following dancer(s):

__ Wayne Chaney Sr. __ Jan Rice __ Robert Senske, Jr. __ Marcelle Epley __ Sofia Riley

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