_____ I would like to join the Benefit Committee. Please list me at
***Annual Benefit Dinner – Public Education for the 21st Century Economy *** Tuesday, February 24, 2015, 6:00pm Cocktails, 7:00pm Dinner The New York Public Library’s Celeste Bartos Forum, Fifth Avenue at 42nd Street _____ I would like to join the Benefit Committee. Please list me at the ________________ level and send me 10 invitations to share with my friends. BENEFIT PACKAGES _____ Chancellor - $50,000 and Above Includes 20 tickets; acknowledgement on the UA website, listing in the printed event program and event slide show; prime seating. Private tour of UA school of choice. _____ Superintendent - $35,000 Includes 20 tickets; listing in the printed event program and event slide show; prime seating. Private tour of UA school of choice. _____ Assistant Superintendent - $25,000 Includes 10 tickets; listing in the printed event program and event slide show; prime seating. Private tour of UA school of choice. _____ Principal - $15,000 Includes 10 tickets; listing in the printed program and event slide show; preferred seating. _____ Assistant Principal - $10,000 Includes 10 tickets; listing in the printed program and event slide show. _____ Dean - $5,000 Includes one ticket and listing as Dean in the printed program. _____ Teacher - $2,500 Includes one ticket and listing as Teacher in the printed program. _____ Tutor - $1,000 Includes one ticket and listing as Tutor in the printed program. _____ I would like to sponsor the event admission for ___ students, principals and/or teachers at $250 each. _____ I am unable to attend, but wish to make a donation of $ . Name (Name or company as you wish to be listed) Address City/State/Zip Telephone Fax Email ___ Enclosed is my check for $___________ payable to The Urban Assembly. ___ Please bill my credit card: __ American Express __ MasterCard __ Visa __ Discover ________________________________________________________________________________________________________ Name on Card Card # CVV Code Exp. Date ___________________________________________________________________________________________________________________________________________________________________________________________ Signature Please list seating preferences or names of guests on the back of this form. PLEASE FILL OUT THIS FORM AND SEND BY MAIL OR FAX TO THE ATTENTION OF JEREMY GOUGH The Urban Assembly, 90 Broad Street, Suite 2101, New York, NY 10004 Phone: (212) 867-3060 Fax: (212) 867-8141 Email: [email protected] All but $250 per ticket is deductible for income tax purposes.
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