* Indicates Required Field
The 2012 Grand Gala Ball
MODERN
FRIDAY, OCTOBER 12, 2012


Ticket/Table Information:*

I/We would like to make an early reservation for:

Qty. Type Price Total
Grand Underwriter Table
Prioritized table for ten around the dance floor, and special recognition at the event

$75,000
Major Underwriter Table
Preferred table for ten around the dance floor

$50,000
Underwriter Table
Table for ten with preferred seating downstairs in Cullinan Hall

$35,000
Benefactor Table
Table for ten downstairs in Cullinan Hall

$20,000
Sponsor Table
Table for ten along the railing in Upper Brown Pavilion

$10,000
Individual Benefactor Ticket
Seating at a table downstairs in Cullinan Hall

$2,000
Individual Patron Ticket
Seating at a table along the railing in Upper Brown Pavilion

$750
All responses of $2,000 and above received by September 28, 2012, will be listed in the program.
The fair market value of each table is $1,000 and the fair market value of each reservation is $100.


I am/We are unable to attend, but enclosed is a fully tax-deductible donation of $:


 
Total Charge:  

After Fair Market Value (FMV) is applied, the remainder of your gift is tax-deductible.

I wish to waive all benefits and make this gift 100% tax-deductible.

Name (as you wish to appear on all printed materials):

Personal Information:

Title:Mr.  Mrs.  Ms.  Miss

Last Name*:


First Name*:




Corporate Contact:


Address*:



Address 2:


City*:



Zip / Postal Code*:
State / Province*:

Country:


E-Mail*:



Phone Number*:



Payment Information:

Credit Card Type*:


Expiration Date*:


Credit Card Number*:


Security Code*:



Billing Information:


Same as Personal Information

Title:Mr.  Mrs.  Ms.  Miss

Last Name*:


First Name*:


Address*:



Address 2:


City*:



Zip / Postal Code*:
State / Province*:

Country:




For information, contact Development Special Events at 713-639-7523.
E-mail seating requests and guest lists to GrandGalaBall@mfah.org or Fax 713-639-7595.




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2013 The Museum of Fine Arts, Houston