Honorary Committee Reservation Form

□ Yes! I/We will join the Honorary Committee at the level of $150 per person. Please list
my/our name(s) in the invitation and online as follows:

_______________________________________________________________________
(Name as you wish it to appear in all event materials)

□ Yes! I/We would like to be a Table Captain, and reserve a table of 8 seats at the
Honorary Committee level of $150 per person for a total of $1,200. Please list my/our
The University name(s) in the invitation and online as follows:
Club of Albany
Foundation _______________________________________________________________________
(Please list names of those at your table – eight total – on the reverse as they should appear in event materials.)
New Year’s Eve
□ My company will join the Corporate Honorary Committee at the level checked below.

Gala Corporate Honorary Committee members receive the number of Honorary Committee tickets
indicated as well as the company or organization name listed on the event invitation and online.

□ $500 (2) □ $1,000 (4) □ $1,500 (6) □ $2,000 (8)

2010 Please list my company in the invitation and online as follows:
Event Committee
(In Formation) _______________________________________________________________________
(Company name as you wish it to appear in event materials – please list names of guests on the reverse.)
Vito Grasso
Co-Chair
□ We are unable to join the Honorary Committee, but wish to make a tax-deductible
Colleen M. Ryan donation to the University Club of Albany Foundation, Inc. in the amount of $ .....................
Co-Chair
Matthew Badalucco Please select your method of payment:
Doug Boettner □ Check enclosed. Make checks payable to the University Club of Albany Foundation.
Eric Hoppel
Michael Hurt □ Credit Card - Please charge my MasterCard ● Visa ● American Express (circle one).
Lili Kelly
Amy Hines Kramer Amount to be charged: $_______________
Frank Nemeth
Paul Veillette Name as it appears on card: .................................................................................................

Please return this form by Account #: ...................................................................... Expiration Date: ........................

November 12, 2010 to:
Signature: .............................................................................................................................
University Club Foundation
141 Washington Avenue
Albany, NY 12210 Do we have your correct contact information? If not, please fill in below.
Attn: New Year’s Eve Gala
Mailing Address: ....................................................................................................................
Thank you for supporting
the University Club of City, State & ZIP: ..................................................................................................................
Albany Foundation!
Home Phone #: .......................................... Work Phone #: ..............................................

E-mail Address: ....................................................................................................................