2nd Annual BEN-efit Sponsor Form
Casino Nights
March 25 or 26, 2011
( ) Event sponsor $ 200.00
( ) Individual table sponsor $150.00
( ) T-shirt sponsor (name on back) $50.00
( ) Group Table Sponsor $50.00
( ) Other donation $_____
Please make checks payable to “The Ben Stear Fund”.
Individual/family name or corporate name:__________________________
Address: _____________________________________________________
_____________________________________________________________
Phone Number: ____________________________
Please mail form and check to:
Denise DiRugeris
103 Michaels Court
Chalfont, PA 18914
215-313-4205
WWW.BENSTEAR.ORG