Texas Health Resources

23rd Annual Black & White Gala

Saturday, August 15, 2015

Omni Fort Worth Hotel

Please return by Friday, July 17, 2015 in order to receive full recognition in our printed materials

A REDasterisk (*) denotes required fields. After completing all fields click on the Submit button.

Name of Company, Foundation or Individual: *

(Please list as you would like to be recognized in printed materials.)

Contact Name:  


     State:*      Zip:*

Phone:       E-mail:*  

Cell Phone:  


Seating priority is based on sponsorship level and date payment is received
(Please indicate the number of desired tables at the appropriate level in the blank to the left.)

Black Diamond Sponsor - $10,000
  • One table for 10 with first priority seating
  • Prominent recognition on ballroom screens
  • Special recognition from the podium at the Gala
  • Signage on the table
  • Prominent recognition in the event program
  • Recognition in the Foundation Annual Report
Diamond Sponsor - $5,000
  • One table for 10 with excellent seating
  • Recognition on ballroom screens
  • Signage on the table
  • Recognition in the event program
  • Recognition in the Foundation Annual Report
Gold Sponsor - $1,750
  • One table for 10
  • Signage on the table
  • Recognition in the event program
  • Recognition in the Foundation Annual Report

  I am unable to attend, but please accept my donation of $

Payment Information

*** Amount *  

Card Type:

Please enter information below exactly as it appears on the credit card.

Cardholder Name: *
Card Number: *
Expiration Date: *

*** Tables will be prioritized by table level and date contract and payment are received. ***

I (We) do not wish to be listed in the program.

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Texas Health Resources Foundation
612 E. Lamar Blvd., Suite 300
Arlington, Texas 76011

682-236-5201 - Fax

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