The Hispanic Chamber of Commerce

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					Yes! I would like to attend the Hispanic Chamber of Commerce 32nd Annual Noche de Gala

Name
Company
Address
Phone                                                                 Fax
E-Mail

I commit to the following level of support:
          ____   Small Business Table of Ten (Before Oct. 15)       ........... $750.00
          ____   Small Business Table of Ten (After Oct. 15)       ............ $900.00
          ____   Corporate Table of Ten (Before Oct. 15) ………... .......... $900.00
          ____   Corporate Table of Ten (After Oct. 15)      ………... $1,200.00
          ____   Benefactor (2 Banquet & 2 VIP Reception tickets) ....... ... $750.00
          ____   Individual Tickets (Before Oct. 15)      ….………….                $ 75.00
          ____   Individual Tickets (After Oct. 15) ……….………… ......... $100.00
                                                             Total
Method of Payment:

All early payments must be received by or postmarked by Oct. 15.
    Check (Make checks payable to the Hispanic Chamber of Commerce of Greater Kansas City)
    Bill Me (Additional $2 billing fee)
    Charge (Visa / Master Card / American Express)


Credit Card#                                        Exp. Date                  Signature
          Please fax this completed form to 816-472-1252; mail to the Hispanic Chamber of Commerce at
                            1600 Baltimore Avenue, Suite 250, Kansas City, MO 64108;
                                or call 816-472-6767 to make a payment by phone.

				
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