reserve your tickets or table today by MMIHouston


									                                           2013 Signature Chefs Gala
                                            Friday, October 25, 2013
                                           Hilton Americas - Houston

                                UNDERWRITING COMMITMENT FORM
Please print (or type) name exactly as you wish it to appear in printed materials

Contact Name:________________________________________________________________________________________

Address: ______________________________________________________________________________________________

City: ____________________________                             State: ______________           Zip Code: _____________________
_____ $50,000 Table for Twelve                                 _____ $10,000 Table for Ten

_____ $25,000 Table for Ten                                    _____ $5,000 Table for Ten

_____ $15,000 Table for Ten                                    ______ $3,500 Table for Ten (limited)

_____     I/We would like to make a donation to “FUND THE MISSION” in the amount of

_____ $10,000 _____ $5,000_______ $2,500______ $1,000 _______ $500 _____ $250 _____ other

In honor of _____________________________ ________ for the 2013 Signature Chefs Gala

*** If you are splitting the cost of the table with others, please enclose a list of names,
phone numbers, and amounts each will pay.
*** Table placement will be made based on sponsorship level and date of commitment.

Please make checks payable to MARCH OF DIMES or check here _____ if you would like to
be invoiced September 1, 2013.
Please charge my credit card ______                            Signature_________________________________________
Name on Card:____________________________________________________________________________________

Card Number:_________________________________Exp. Date_________________Security Code________


Phone: _________________________________________                                Fax:___________________________________

E-mail Address: ___________________________________________________________
Please fax or e-mail completed form to Katie Nixon at 713.964.5417 or mail to 3000 Weslayan, Suite 100, Houston, TX, 77027. For
additional information, contact March of Dimes at 713.623.2020 or The deadline for inclusion of table
sponsors in the invitation is September 6, 2013. For IRS purposes, the fair market value of each seat is $60. Contributions will be
acknowledged with a receipt letter for tax purposes.

To top