5th Annual Joan Hisaoka Gala

Get Your Tickets and Tables

All sponsors contributing $3,000 or more will be listed in both the printed invitation and the program journal if response and payment are received by July 19, 2013.

All other sponsors will be listed in the program journal if response and payment are received by August 27, 2013.

Please complete the pledge form below in your browser, then print a copy and mail or fax to:

Make a Difference Gala
c/o Vivian Thompson-Goldstein
1302 Fairgrove Lane
Crownsville, MD 21032
Email: JoansDifference@aol.com
Phone: (202) 302-0053
Fax: (410) 923-0509

* Required Fields

*Name:
*Company:
*Address:
*City:
*State:
*Zip:
Business Number:
*E-mail Address:
Fax Number:
Your name as it should appear in the invitation and/or program:
I/ we will attend the Sixth Annual Joan Hisaoka "Make a Difference" Gala on September 21, 2013 at the The Omni Shoreham in Washington, D.C., and would like to support Life with Cancer® by making a contribution at the selected sponsorship level(s):
Presenting Sponsor $100,000 Three tables of 10 with premium seating
Diamond Sponsor $75,000 Two tables of 10 with premium seating
Platinum Sponsor $50,000 Two tables of 10 with premium seating
Gold Sponsor $25,000 Two tables of 10 - one with premium seating and one with preferred seating
Silver Sponsor $25,000 Two tables of 10 with preferred seating
Benefactor $10,000 One table of 10 with preferred seating
Friend $8,000 One table of 10
Donor $5,000 Six tickets to the Gala
Contributor $3,000 Four tickets to the Gala
Supporter $1,500 Two tickets to the Gala
Individuals $600 per ticket to the Gala
I/ we cannot attend, but would like to make a tax-deductible contribution.
Enclosed is my check made payable to Life with Cancer® in the amount of
$

Completed pledge forms should be sent via mail, email, or fax to:
c/o Vivian Thompson-Goldstein
1302 Fairgrove Lane
Crownsville, MD 21032
Email: JoansDifference@aol.com
Phone: (202) 302-0053
Fax: (410) 923-0509

Life with Cancer® is part of Inova Health System, a 501(c)(3) healthcare system in Northern Virginia. FEIN number 54-1071867.


For sponsors contributing $3,000 or more, payment and form should arrive by July 19, 2013. All other sponsor forms and payments should arrive by August 27, 2013.

Questions may be addressed to Vivian Thompson-Goldstein via the phone number or email address listed above.

Your 2013 Tax Deductible Contribution will benefit Life with Cancer the Smith Center, and The Brem Foundation.

For more information, contact Vivian Thompson-Goldstein Tel: (202) 302-0053 | Fax: (410) 923-0509