I would like to be a SPONSOR at the following level: 
     Platinum ($5,000) Gold ($2,500) Silver ($1,500) Bronze ($750) Partner ($250)

Sponsor Name: 

Contact Name:  

Street:   City:  State: ZIP:

Phone: 

I would like to purchase INDIVIDUAL RESERVATIONS at $100 each, totaling $

Name:  Street:  
City:   State:   ZIP:  Phone:

Please make reservations for the following individuals: return to top

I AM UNABLE TO ATTEND, but would like to contribute $ for the children.


PAYMENT METHOD

Check (payable to Make a Difference 2006) 
Print form and mail to: P. O. Box 140767, Austin, TX 78714, Att: Make a Difference
Please Note: Reservations must be received at LSS by Feb. 24, 2006.

Attention SPONSORS: Your form must be received at LSS by Dec. 21, 2006 in order for
you to be listed as a sponsor on the invitation. return to top

   VISA   Master Card Discover Card (please go to the NEXT PAGE to complete transaction) 

Email Address Required to pay via Credit Card: 

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