Sponsor Application Name of Company, Foundation or Individual * (please list the name as you want it to appear in the event materials) Address * Email * Phone Sponsorship Levels * Presenting ($100,000) Visionary ($75,000) Pioneer ($50,000) Innovator ($25,000) Forerunner ($10,000) Benefactor ($7,500) Patron (Individual tickets at $750 per person) We are unable to attend and decline the Gala tickets and sponsorship benefits. Please consider our Sponsorship a 100% charitable gift. Number of Patron tickets requested. Please select your preferred method of payment: * Invoice (An invoice will be sent to the mailing address provided.) Credit Card (A UAMS representative will contact you by phone.) Check (To pay by check, see information below.) Checks should be made payable to Winthrop P. Rockefeller Cancer Institute with “Gala ‘22” in the memo line. Mailing Address: Winthrop P. Rockefeller Cancer Institute 4301 W Markham Street Slot # 623F Little Rock, AR 72205 Upload Your Logo for Website Minimum dimensions: 884×538. The image must be a PNG with a transparent background or a vector-based file. Signature Authorizing Sponsorship Commitment A receipt for your sponsorship gift will be provided, less the amount of the fair market value of goods and services offered with each sponsorship. If you are human, leave this field blank. Submit
