Virginia Treatment Center for Children

Butterfly Ball - Third Annual Child Mental Health Gala

Willow Oaks Country Club

Friday, September 25, 2009 7 p.m. until 11 p.m.

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Ticket Purchase

To pay by check or credit card, please print and fill out this form and mail to address below.

 

MAKE YOUR RESERVATIONS TODAY

 

£      Monarch Sponsor - $1200

            8 tickets to the Butterfly Ball

            Recognition at the Event

 

£      Event Ticket –   $75 each  

            Number of tickets ________

 

£      Gift – I/We are unable to attend, but have enclosed a contribution in the amount of         $_______________.

 

For more information please contact Delores Richards-Madikiza at 804.828.1123 or drichards-madikiza@mcvh-vcu.edu

 

NOTE TO SPONSORS:  Information must be received by September 10, 2009 to be included in the program.

 

Name: ________________________________________________________________________

 

Sponsor Name for Program: ____________________________________________________

 

Address: _______________________________________________________________________

 

City/State/Zip:   ________________________________________________________________

 

Telephone (Day/Evening): ______________________________________________________

 

Email_____________________________________________________________

 

Payment Options:

 

Check for $_________________ (Please make checks payable to: VTCC Advisory Council)

 

1 VISA     1 MasterCard   Card Number________________________________________________   

Exp. Date _____________

 

Name on Account___________________________________________________________________

 

Signature_____________________________________________________________________________

Thank you for your support!  $25 of each ticket is tax deductible.

 

Advisory Council of the Virginia Treatment Center for Children
800 E. Leigh Street, Suite 150   Richmond, VA 23219

www.virginiakids.net

Tax ID # 52-1586450

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