“An Afternoon of Tagore” with Rezwana

Sponsorship Form
Once you have selected your desired level of sponsorship, please complete the below
form.

Shraddhanjali (Gift of Devotion) Sponsors – $1,000

Pushpanjali (Gift of Flowers) Sponsors – $500
Kavitanjali (Gift of Poems) Sponsors – $250
Suvalnanjali (Gift of Gold) Sponsors – $100

Name: ______________________________________________

Address: _____________________________________________

City / State / Zip Code: __________________________________

Phone: ____________ Email Address: _______________________

 Check Please make checks payable to Huntsville Hospital Foundation.

Donation Amount $______  MasterCard  VISA  American Express  Discover

Card Number __________________________________ Exp. Date _________

101 Sivley Road • Huntsville, AL 35801 • Tel: 256.265.8077 • Fax: 256.265.9456 •
www.huntsvillehospital.org/foundation