Name of Company, Foundation or Individual(Required)(please list the name as you want it to appear in the event materials)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email(Required) Sponsorship Levels(Required) 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.(Required)Not Attending the Event? If you can’t attend the Gala for Life but still want to support critical cancer research and patient care at UAMS, your gift matters more than ever. Please consider making a meaningful contribution today—even from afar—by donating here. Your generosity helps fund life-changing breakthroughs and brings hope to patients and families facing cancer.Please select your preferred method of payment:(Required) 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 for Life” in the memo line. Mailing Address: Winthrop P. Rockefeller Cancer Institute 4301 W Markham Street Slot # 623-2 Little Rock, AR 72205Upload Your Logo for WebsiteAccepted file types: jpg, gif, png, pdf, Max. file size: 15 MB. Minimum dimensions: 884×538. The image must be a PNG with a transparent background or a vector-based file.Signature Authorizing Sponsorship Commitment(Required)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.
