Annual Gala Sponsor Form The Achievement Center of Texas is a 501(c)(3) Texas Nonprofit Corporation. We provide day habilitation for children and adults with disabilities. Our fundraising activities allow us to keep tuition affordable and available. Name First Last Company*Name of the corporate sponsor.Phone*Please provide a telephone number so we can contact you. Sponsorships require additional information not provided on this form.Address Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email*Please provide the email address for the contact person. Some of the follow-up can be completed via email. Enter Email Confirm Email Future Email Use Content*Do we have your permission to reach out to you in the future regarding other events we'll be hosting? Yes No Sponsorships*Please select the sponsorship amount from the drop down. Names for attendees can be provided at a later date. If you only want individual event tickets, individual tickets are available, visit the general registration page by clicking here. The payment section includes a "pay by check" option.Please select your participation levelTitle Sponsor - $15,000Champions Who Care Sponsor - $10,000Casino and Entertainment - $5,000Table of 10 - $1,500Linda Rasmussen Outreach - $500Guest Names and/or Special Instructions*You will be contacted prior to the event for names and menu options. You may also email the list to firstname.lastname@example.org. Choose "I have special requests or restrictions for my table." if you want to donate your tickets, remain anonymous or decline all benefits.I will supply guest names at a later time.I have special requests or restrictions for my table.The Title Sponsor's name will be added to the event name. You will also receive up to 3 tables, podium recognition, website links, full page program advertising and additional advertising as may be available at the event and pre-event activities. How many Title Sponsor tables?I would like 1 table of 10I would like 2 tables of 10I would like 3 tables of 10The Champions Who Care Sponsor receives up to 2 tables, podium recognition, website links, full page program advertising and additional advertising as may be available at the event.How many tables?I would like 1 table of 10I would like 2 tables of 10The Casino and Entertainment Sponsor receives 1 table of 10, podium recognition, website links, full page program advertising with casino theme and additional advertising as may be available at the event.Table Sponsors receive a table seating 10 guests, website links and program mention. These tables include advertising so if you would like a regular table for 10 you may get one for $1,200 (individual tickets are $125. each) using the following link. For individual tickets and tables without advertising, visit the general registration page by clicking here.Linda Rasmussen Outreach Fund receives website links (if wanted) and program mention in the LRO section. Special InstructionsYou may select more than one option. I am unable to attend and would like to donate the seats at my table. I/We request that this contribution remain anonymous. I/We decline all benefits. (Only the contributions in excess of the benefit package is deductible as a charitable contribution unless all benefits are declined.) Total $0.00 Payment SectionPayment Type*Select OneCredit CardPaypalInvoice / CheckThis page is unsecured. Do not enter a real credit card number! Use this field only for testing purposes. Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20172018201920202021202220232024202520262027202820292030203120322033203420352036 Expiration Date Security Code Cardholder Name You will be directed to Paypal to complete your paymentYour registration will be recorded. You will be contacted if there are questions or if your check isn't received before 4/10/2017. Please mail checks to: Achievement Center of Texas Attn: Roberta Clark PO Box 452826 Garland, TX 75045-2826 Please print this page and include with your check.Deadlines, comments, etc.In order to have recognition in the program, please complete this form no later than Friday, April 14, 2017. Logos and/or ads for the program must be submitted by this date as well. Vector art is required for print.NameThis field is for validation purposes and should be left unchanged.