Las Patronas

69th Annual Jewel Ball

August 8, 2015
Tax ID #95-6051480
_______________________________________________________________________________
Underwriting Level - Please Check One

Platinum
$50,000+

Crown Jewel
$30,000+

Diamond
$20,000+

Ruby
$15,000+

Emerald
$10,000+

Sapphire
Topaz
$5,500+
$3,500+

Pearl
$1,000+

_______________________________________________________________________________
Underwriter Information
Name: _______________________________________________________________________________________________________________________________________________________________________
Company: __________________________________________________________________________________________________________________________________
Address: _____________________________________________________________________________________________________________________________________________________________________
City, State and Zip:
Telephone ____________________________________________________Fax:
I would like to underwrite

General Ball Expense

Email:

or

Your Signature ___________________________________________________

(Please select from the Recognition Choices list)

Date _______________________

_______________________________________________________________________________
Publicity, Recognition and Signage
Contact for publicity & recognition purposes

Phone

Name you would like used for publicity & recognition purposes
For my complimentary Jewel Ball Program Book Advertisement (Emerald level and above):
Please use my artwork on file

I will provide a new ad

I will provide artwork, please design my ad

I prefer not to run an ad

_______________________________________________________________________________
Payment and Ticket Purchases
Check enclosed (payable to Las Patronas) in the amount of $

for Jewel Ball 2015.

Please charge my (circle) American Express, Discover, MasterCard or Visa in the amount of $
Card Number

for Jewel Ball 2015.

Exp. date

CSC/Security Code

Name as it appears on the card

Billing Zip

Please accept my signed contract now for the amount of $

and defer payment until May 1, 2015.

A gift of stock
(Las Patronas will send you instructions for your stock transfer)

I would like to purchase

additional Ball tickets for Jewel Ball 2015.

_______________________________________________________________________________
Full payment must be received by May 1, 2015 to guarantee your benefits.
Please return this copy to: Las Patronas, c/o Lisette Farrell, 6115 Terryhill Drive, La Jolla, CA 92037

For more information, please contact Maureen Weber, at (858) 735-0577 or email: mweberlj@gmail.com
Please retain yellow copy for your records.