Mirowitz Gala- There’s No Place Like Mirowitz Name* First Last Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Corporate Sponsorship Levels For Corporate Sponsorship Level benefits, please contact Margo Newman at email@example.com or 314-576-6177.Ruby Sponsor Price: $ 13,000.00 Quantity: Gold Sponsor Price: $ 5,400.00 Quantity: Silver Sponsor Price: $ 3,600.00 Quantity: Sponsorship LevelsEmerald City Price: $ 18,000.00 Quantity: • Two tables of 10 • VIP table placement • Complimentary valet for guests • Presenting Sponsor recognition from stage • Unlimited tributes • Logo recognition as Presenting Sponsor on all gala publicity and mailings (invitation, program, press release, signage, e-newsletter and website) Ruby Slippers Price: $ 13,000.00 Quantity: • One table of 10 • VIP table placement • Complimentary valet for guests • Recognition from stage • Unlimited tributes • Listing on all gala publicity and mailings The Wise Scarecrow Price: $ 5,400.00 Quantity: • One table of 10 • Recognition from stage • 10 tributes in the dinner program • Listing on all gala publicity and mailings The Loving Tin Man Price: $ 3,600.00 Quantity: • 4 dinner tickets • 5 tributes in the dinner program • Listing on all gala publicity and mailingsThe Brave Lion Price: $ 1,800.00 Quantity: • 2 dinner tickets • Listing on all gala publicity and mailingsGala ReservationsIndividual Tickets Price: $ 150.00 Quantity: Alumni Ticket Price: $ 75.00 Quantity: Fund the NeedI wish to pre-bid at a "Fund the Need" level of: Price: $ 10,000.00 Quantity: I wish to pre-bid at a "Fund the Need" level of: Price: $ 5,000.00 Quantity: I wish to pre-bid at a "Fund the Need" level of: Price: $ 2,500.00 Quantity: I wish to pre-bid at a "Fund the Need" level of: Price: $ 1,000.00 Quantity: I wish to pre-bid at a "Fund the Need" level of: Price: $ 500.00 Quantity: I wish to pre-bid at a "Fund the Need" level of: Price: $ 250.00 Quantity: I wish to pre-bid at a "Fund the Need" level of: Price: $ 100.00 Quantity: Tax Deductible Contribution If you can't attend, please consider making a 100% tax-deductible contribution.Tributes Tributes will be listed in the dinner program. Tributes are $50 each. Please note the total number of tributes in the box below. Each category (children, grandchildren, etc.) counts as one tribute. This form will not automatically total your tributes. Tributes Price: $ 50.00 Quantity: I would like to make a Tribute To the Honorees: Randee and Dr. Myron Jacobs To the Honoree: Dr. Barbara Green To the Chairs: Carly Sparks and Marilyn Levison To the continued success of Mirowitz To the 20 year employee: Rick Schmidt To the 15 year employee: Becky Lerner To the 10 year employee: Suzanne Burack To the 5 year employees: Gaby Tullman and Gary Lerner To my childrenTo the teachers and staffTo my grandchildrenIn honor ofIn memory ofdining & table seating requests The entree will be salmon. Dietary laws will be observed. Please indicate below if you prefer a vegetarian meal or have any additional dietary restrictions. We will make every effort to honor table seating requests. Please indicate vegetarian or other dietary requestsPlease seat me/us with the following peopleOther seating option Please sit me/us with other parents from my child's class. Help us cover costs. Simply leave "Yes!" checked below to ensure that 100% of your intended donation is available for our mission.Yes! I want to add an additional 3% to my contribution to cover processing fees.No. I want Mirowitz to cover the processing costs.Thank you for helping Mirowitz cover our processing fees. Price: $ 0.00 Total $ 0.00 payment information American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name This iframe contains the logic required to handle Ajax powered Gravity Forms.