42^nd Annual Auxiliary Ball - Dancing with the Stars

Saturday, March 20, 2010

Jennifer?s Garden, 555 Gore Road, Morris, IL

Cocktails at 6:00 pm~ Dinner at 7:00 pm ~ Raffles, Silent & Live Auctions,

Dancing to the Gold Coast Orchestra.

Black Tie Optional

Proceeds from this year?s event will benefit the purchase of SimMan ? a human patient simulator for teaching purposes

For questions concerning this event, please contact: Val Starr (815) 942-2932 ext. 7008 or vstarr@morrishospital.org

Pursuant to IRS Revenue ruling, we are required to advise you that the fair market value of this event is $78 per person. The remainder will be considered a charitable contribution.

* First Name * Last Name * Address * City * State * Zip Code * Phone * E-mail Sponsorship * Please select a level: Corporate Sponsor - $1,500 per table Diamond Benefactors - $1,000 per couple Platinum Benefactors - $500 per couple Gold Benefactors - $350 per couple Silver Benefactors - $280 per couple Seating Seating Preference (10 names max): Donation I will not be able to attend, but wish to make a donation of: $ Sub Total $ * Card Number (no spaces) * Expiration Date 01 02 03 04 05 06 07 08 09 10 11 12 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 * CCV Number (sample)

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