A Safe Place

Name:        Agency/Organization:    Email:       
Address:                 City:       State: 
Zip:                     Phone:      Fax:     

Guest Name(s) (Use commas to separate names):

# of tickets you would you like reserved at $150 each:
(tickets will be held at the door and must be paid in full by 10/08/08)
I cannot attend but wish to make a tax deductible contribution in the amount of: $

I wish to sponsor the event at the following level:
Guardian Angel $25,000 includes 15 event tickets front or back cover, list as sponsor
Golden Angel $15,000 includes 10 tickets, full page ad, listed as sponsor
Crystal Angel $10,000 includes 5 tickets, half-page ad, listed as sponsor
Angel of Hope $2,500 includes 2 tickets, quarter page ad, listed as co sponsor
Supporting Angel $150 listed in program as a donor

Program Ad Information (Deadline for all submissions is September 10, 2008)
(All ads for booklet need to be camera ready.)
Full Page $2,000.00
Half Page $1,000.00
Quarter Page $500.00
Business Card $50.00

Silent Auction Item:
(Silent auction items should be dropped off at a Safe Place Administrative office no later than October 1st. (Please call (510) 986-8600 to make arrangements.)

Check here if you would like your donation to be anonymous. yes

Check enclosed for: $ (Make payable to: A Safe Place.)

Please mail your completed form with your payment to: A Safe Place, P.O. Box 23006, Oakland, CA 94623. Fax: (510) 986-8606



On-Line Payment Option:

(Please include 2.89% service charge for on-line payment.)
Enter Amount: $
Add Service Charge: $
Total: $


Verification Code:



For payments made by Visa/MasterCard/American Express, go to Celebrating Courage on our website.



Back