Celebrity Fashion Show Response Form

(please type answers, print, and mail or fax this form)

Name:

Company Name (if applicable):

Address:

City:

State: Zip:

Telephone Number:                      Facsimile Number:
()           ()

Table/Ticket Options:
$500 and number of tables/ads:
$370 and number of tables:       
$100 and number of ads:           
 $40 and number of tickets:      

Total amount of check/credit card authorization: $

Credit Card Information:      Visa      Mastercard

Account Number:                                               Expiration Date:
          

Signature: (please do not type; print and then sign in pen ink)

Date:

Contact person for Camera Ready Artwork:

Telephone Number:                      Facsimile Number:
()           ()

Reminder:
Camera Ready Artwork (4" width by 5" length) is due by Friday, April 10, 1998 and advertisements in the event program book are only available at the $500 and $100 levels.

For more information, please contact Sandra Fields, Development Director, at 703-359-4440, extension 110.

Please make checks payable to: "The Alzheimer's Association, Northern Virginia Chapter" and indicate that you are making a donation for the "Celebrity Fashion Show."

Send all information to:

Alzheimer's Association, Northern Virginia Chapter
10201 Lee Highway, Suite 210
Fairfax, VA 22030
(FAX) 703/359-4441

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Last updated: April 9, 1998

© 1997 & 1998 Alzheimer's Association, Northern Virginia Chapter. All rights reserved.

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