November 9, 2011
Harris Theater
205 E. Randolph Drive
Chicago, IL 60601
REGISTRATION FORM
Contact Name_____________________________ Phone Number__________________________
Address_______________________________________________________________________
Email Address __________________________________________________________________
Donor’s Name Exactly as It
Should be Listed in Printed Materials__________________________________________________
□ I do not wish to be listed in the program or any other printed materials
Please reserve the following:
□ Visionary- $100,000 □ Preferred Stock- $5,000
25 tickets 3 tickets
□ Senior Secured- $50,000 □ Common Stock-$1,000
15 tickets 1 ticket
□ Host Committee/Mezz Debt- $25,000 □ Pre IPO (under 35)- $500
10 tickets 1 ticket
□ Convertible Debt- $10,000 □ I am unable to attend but would like to
5 tickets support Invest For Kids in the amount
of $ ____________
Total Number of Tickets: __________
List Attendees Here: _______________________________________________________________
________________________________________________________________________________
PLEASE NOTE PAYMENT INFORMATION
• Space at the conference is limited and will be Please make checks payable to: Invest For Kids
filled on a first come, first served basis. Mail payment along with a completed
• All attendees are invited to the cocktail registration form to:
reception following the conference.
• Payment must be received to guarantee your Invest For Kids
reservation. Attention: Gina Rosanova
• 100% of the money raised will directly benefit 875 North Michigan, Suite 3400
local children. Chicago, IL 60611
• Registration deadline is October 31, 2011. Email: info@ifkchicago.com
Invest For Kids • 875 N. Michigan Ave, Suite 3400 • Chicago, IL 60611 • 312.664.5050 • Fax 312.664.8983
www.investforkidschicago.org