LEADERSHIP Response Form
Your response must be received byJanuary 31, 2017in order for you to be listed on the invitation.
TABLES INDIVIDUALS
____Chairman’s Circle:$20,000
(Includes premium table of ten, champagne with dessert, recognition on invitation and program, and invitation for two to the March 28th cocktail reception hosted by Anne and Tom Hubbard and Helen and DuWayne Sayles at The Brook Club)
____President’s Circle:$15,000
(Includesprime table of ten, champagne with dessert, recognition on invitation and program, and invitation for two to the March 28th cocktail reception hosted by Anne and Tom Hubbard and Helen and DuWayne Sayles at The Brook Club)
____Director’s Circle:$10,000
(Includes priority table of ten,recognition on invitationand program, and an invitation for two to the March 28th cocktail receptionhosted by Anne and Tom Hubbard and Helen and DuWayne Sayles at The Brook Club)
____Junior’s Circle(ages 35 and under):$3,500
(Includes table of ten, and recognition on invitation and program)
____Underwriter: $2,500
(Includes dinnerfor one at premium table, recognition on invitation and in program, and invitationfor one to the March 28th cocktail reception hosted by Anne and Tom Hubbard and Helen and DuWayne Sayles at The Brook Club)
____Benefactor:$1,500
(Includesdinnerfor one at prime table and recognition on invitation and in program)
____Sponsor: $1,000 (Includes dinnerfor one and recognition on invitation and in program)
____Friend: $600 (Includes dinner for one and recognition in program)
____Dinner Ticket: $500(Includes dinner for one)
____Junior Ticket(ages 35 and under): $400(Includes dinner for one)
____Please seat me at a Junior Table (ages 35 and under)
_____Dancing Only: $140 (Includes practice, dancing and drinks, 9:00 - midnight)
____I/We would like to make a contribution. Although I/we cannot attend, I/we would like to make a tax-deductible contribution of $______. Contributions of $600 or more will be included in appropriate listing on the invitation and/orin the program.
PAYMENT
____Enclosed is my check, made payable to The National Trust for Scotland Foundation USA, in the amount of $______for tickets as indicated above.
____Please charge my credit card in the amount of $______for tickets as indicated above.
Credit Card (circle one): American Express Visa MasterCard Discover
Credit Card No.:______Expiration Date: ______Security Code:_____
Name as it appears on card: ______Signature: ______
______
My/Our Names(AS THEY SHOULD APPEAR ON PRINTED MATERIALS)
______
Address
______
City/State/Zip Email Address
______
Daytime Telephone Evening Telephone Fax Number
PLEASE NOTE: All but $205 per person is tax-deductible according to applicable Federal tax law.
The National Trust for Scotland Foundation USA, Inc. is a 501(c)(3) corporation registered in the Commonwealth of Massachusetts. Federal Tax ID No. 04-3511088.
Please return this form to the address below by post, fax(617-227-4200), or email ()
The National Trust for Scotland Foundation USA, 45 School Street, 3rd Floor,Boston, Massachusetts 02108