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					6TH ANNUAL                                                                             AT&T PERFORMING ARTS CENTER

GIBI INVESTMENT                                                                        WINSPEAR OPERA HOUSE
                                                                                       DALLAS, TEXAS


SYMPOSIUM                                                                              Benefiting
                                                                                       THE MICHAEL J. FOX FOUNDATION
                                                                                       FOR PARKINSON’S RESEARCH
                                                                                       & VICKERY MEADOW YOUTH
TUESDAY, OCTOBER 30, 2012                                                              DEVELOPMENT FOUNDATION


                                                                                       ANGEL INVESTOR — $100,000
 UNDERWRITING FORM                                                                         •	 Fifty	(50)	tickets,	preferred	seating
 CONTRIBUTION LEVELS                                                                       •	 Ten	(10)	tickets	to	Underwriter	and	Speaker	Luncheon
                                                                                           •	 Invitation	for	ten	(10)	to	Underwriter	Party
   		Angel	Investor	–	$100,000		            		Breakout	Investor	–	$50,000	                 •	 Sponsor	table	at	cocktail	reception
   		Perfect	Hedge	–	$25,000		              		Lead	Investor	–	$12,000	                     •	 Program	and	website	listing
   		Friends	&	Family	–	$6,000		            		Professional	Ticket	–	$1,000	

   		I	am	unable	to	attend	but	wish	to	make	a	contribution	of	$	________ _____
                                                                       __              BREAKOUT INVESTOR – $50,000
                                                                                           •	 Twenty-five	(25)	tickets,	preferred	seating
 DONOR INFORMATION                                                                         •	 Four	(4)	tickets	to	Underwriter	and	Speaker	Luncheon
 Donor	Name:	 ___________________________________________________                          •	 Invitation	for	four	(4)	to	Underwriter	Party
 (Exactly	as	it	should	be	listed)	                                                         •	 Sponsor	table	at	cocktail	reception
 Contact	Person:	 ________________________________________________                         •	 Program	and	website	listing

 Address:	 ______________________________________________________
                                                                                       PERFECT HEDGE – $25,000
 City	/	State	/	Zip:	__________________________________________________                    •	 Fifteen	(15)	tickets,	preferred	seating
 Email:	_________________________________________________________                          •	 Two	(2)	tickets	to	Underwriter	and	Speaker	Luncheon
                                                                                           •	 Invitation	for	two	(2)	to	Underwriter	Party
                                                              _
 Phone:	_______________________________________________________
                                                                                           •	 Sponsor	table	at	cocktail	reception
   		List	contribution	as	anonymous																			 		Donor	declines	all	benefits       •	 Program	and	website	listing

 ATTENDEE INFORMATION FOR NAME TAGS
 (Please	email	changes	to	info@gibidallas.com	by	October	19)
                                                                                       LEAD INVESTOR – $12,000
                                                                                           •	 Ten	(10)	tickets
                 _
 Name	&	Company:		 _____________________________________________
                                                                                           •	 Invitation	for	two	(2)	to	Underwriter	Party
                 _
 Name	&	Company:		 _____________________________________________                           •	 Program	and	website	listing
                 _
 Name	&	Company:		 _____________________________________________
 Name	&	Company:		 _____________________________________________
                 _                                                                     FRIENDS & FAMILY – $6,000
                                                                                           •	 Four	(4)	tickets
                 _
 Name	&	Company:		 _____________________________________________
                                                                                           •	 Invitation	for	two	(2)	to	Underwriter	Party
                 _
 Name	&	Company:		 _____________________________________________                           •	 Program	and	website	listing
                 _
 Name	&	Company:		 _____________________________________________
 Name	&	Company:		 _____________________________________________
                 _                                                                     PROFESSIONAL TICKET – $1,000
                                                                                           •	 One	(1)	ticket
                 _
 Name	&	Company:		 _____________________________________________
 Name	&	Company:		 _____________________________________________
                 _                                                                     EVENT SCHEDULE
                                                                                          12:00 p.m.	          Underwriter	and	Speaker	Luncheon
 PAYMENT METHOD                                                                           1:00 p.m.	           Check-In	/	Registration
   		Check	–	Please	make	payable	to	Great	Investors’	Best	Ideas	Foundation			             2:00 p.m.	           Symposium
   		Credit	Card	–	Amount:	$	 _______________________________________                     6:00 p.m.	           Cocktail	Reception
   	Visa		 	MasterCard		 	American	Express			                     /
                                                 	Exp.	Date:	___________
                                                                                       PLEASE NOTE
 Credit	Card	#:	___________________________________________________                    Name	tags	will	be	issued	in	lieu	of	tickets	upon	check-in.	All	attendees	are	
                                                                                       invited	to	have	cocktails	and	hors	d’oeuvres	following	the	symposium.
 Name	on	Card:		_________________________________________________	
 Billing	Address:		________________________________________________	                   Please	return	this	form	by	September 14	to	receive	an	Underwriter	Party	
                                                                                       invitation	and	by	October 12	to	ensure	program	listing.
 City	/	State	/	Zip:		__________________________________________________ 	
                                                                                       GIBI	Tax	ID:	20-8884440
 Signature:	______________________________________		Sec.	Code:	______	

Please return completed form to: Great Investors’ Best Ideas foundation, 1901 N. Akard St., Dallas, TX 75201
                                     TEL: 214-754-9997 | FAX: 214-720-2071 | EMAIL: info@gibidallas.com

                                                               gibidallas.com

				
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