Steve Harvey Patron Event – Invoice Only – Health Care Foundation of North Mississippi

YES! I want attend the Steve Harvey Patrons Event benefitting HealthWorks! at the level indicated below. Additionally, my intent is to continue supporting HealthWorks! annually with a sustaining gift. However, my intent is non-binding and should not be considered as a pledge. I may be contacted annually for additional gift requests.

Name *

First

Last

Phone

Address *

Address Line 1

City

State

Zip Code

Name of additional guest (if applicable)

First

Last

Donation Level:

Corporate Patron - $2500

8 pre-event Patrons Party and Steve Harvey's Presentation tickets

Individual Patron - $500

per couple 2 pre-event Patrons Party and Steve Harvey’s Presentation tickets

Sustaining Member - $250

per couple 2 tickets to Steve Harvey’s Presentation

I agree to pay by invoice *

Total

$ 0.00

To complete your registration and pay by credit card, enter the above amount due along with your credit card information on the following pages.

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