Download this form to your computer, fill it in, and then click button to submit: Need help? Call 816-983-2204 or email your information to [email protected] for follow-up. Name To Be Listed in the Invitation and Program: ______Contact Name: ______Company: ______Address: ______City, State, Zip:______Phone: ______Email: ______

Top / Premier Underwriter Two premier tables and complimentary valet parking for 20 guests; event recognition, including premier signage in the main event space and recognition from the stage; 20 benefactor party invitations

Chapeau / Grand Underwriter Premier table and complimentary valet parking for 10 guests; event recognition, including premier signage in the reception area and recognition from the stage; 10 benefactor party invitations

Cloche / Underwriter Premium table and complimentary valet parking for 10 guests; event recognition, including premier signage in the silent auction area; eight benefactor party invitations

Bonnet / Grand Benefactor Preferred table and complimentary valet parking for 10 guests; event recognition; six benefactor party invitations

Beret / Table Benefactor Priority table and complimentary valet parking for 10 guests; event recognition; four benefactor party invitations

Feather In Your Hat / Table Sponsor Prime table and complimentary valet parking for 10 guests; event recognition; two benefactor party invitations

Individual Benefactor Seating for one guest; event recognition; one benefactor party invitation Individual Ticket

Payment Information: Check (Payable to Open Options) Credit Card Name: Credit Card #: SIC#: Date: Donation Only $ (Donationis fully tax deductible) Your tax deduction will be the amount of your contribution less the value of goods provided. You will receive a letter confirming your specific tax deduction after the Luncheon.

Hats Off benefits Life Unlimited, doing business as Open Options, a local nonprofit organization serving people with disabilities in the KC Metro. Tax ID: 43-1237483

Contact: Andrea Adams, Director of Development Direct Line: 816-983-2204 Email: [email protected]