If interested in paying by check, please print and complete this form and mail to the address provided.


Required fields are indicated with an asterisk (*).
SPONSORSHIP OPPORTUNITIES
SelectDescriptionAmount
Please Call TITLE SPONSOR $250,000 ($245,200 is tax-deductible)
  • Three VIP tables of ten (30 guests total)
  • Emerald slide in digital tribute
  • Designated as Title Sponsor on printed materials, press releases and video screens at the event
  • Photo opportunity with honorees and celebrity guests
  • Special, on-stage recognition during the event
To purchase this level of sponsorship, please contact Sam Lang at 310-267-9475 or slang@support.ucla.edu.
Please Call VISIONARY $100,000 ($96,800 is tax-deductible)
  • Two VIP tables of ten (20 guests total)
  • Diamond slide in digital tribute
  • Designated as Visionary Sponsor on printed materials, press releases and video screens at the event
  • Photo opportunity with honorees and celebrity guests
  • Special, on-stage recognition during the event
  • Sponsor eight dedicated UCLA doctors, nurses, or medical care providers to attend the event
To purchase this level of sponsorship, please contact Sam Lang at 310-267-9475 or slang@support.ucla.edu.
TRAILBLAZER $50,000 ($48,400 is tax-deductible)
  • One premier table of ten
  • Platinum slide in digital tribute
  • Designated as Trailblazer Sponsor on printed materials and video screens at the event
  • Photo opportunity with honorees and celebrity guests
  • Special recognition from stage at event
  • Sponsor four dedicated UCLA doctors, nurses, or medical care providers to attend the event
LUMINARY $25,000 ($23,400 is tax-deductible)
  • One preferred table of ten
  • Gold slide in digital tribute
  • Designated as Luminary Sponsor on printed materials and video screens at the event
  • Special recognition from stage at event
  • Sponsor two dedicated UCLA doctors, nurses, or medical care providers to attend the event
INNOVATOR $10,000 ($8,400 is tax-deductible)
  • One preferred table of ten
  • Silver slide in digital tribute journal
PIONEER $7,500 ($5,900 is tax-deductible)
  • One table of ten
  • Bronze slide in digital tribute journal
Sub-Total:
Tax-Deductible:
INDIVIDUAL DINNER TICKETS
QuantityDescriptionAmount
      PARTNER $750 ($590 is tax-deductible)

Please reserve dinner tickets) at $750 per ticket
Sub-Total:
Tax-Deductible:
TRIBUTE COPY DEADLINE: THURSDAY, SEPTEMBER 26, 2019
DIGITAL TRIBUTE

If you cannot attend but would like to share a personal message to congratulate this year’s honorees and UCLA Neurosurgery, please use this opportunity and form to provide an on-screen tribute during the event (100 percent tax-deductible).

Include your name and message of 40 words or less per page. We also encourage electronic art, logos, and photographs (EPS, TIFF or JPEG with a minimum 300 dpi at 100% size).

Please email ads to rebecca@grantevents.com.


SelectDescriptionAmount
EMERALD 15"W x 8"H; 60 secs. on-screen - $50,000
DIAMOND 15"W x 8"H; 50 secs. on-screen - $35,000
PLATINUM 15"W x 8"H; 40 secs. on-screen - $25,000
GOLD 15"W x 8"H; 30 secs. on-screen - $10,000
SILVER 15"W x 8"H; 20 secs. on-screen - $5,000
BRONZE SLIDE - 15"W x 8"H; 15 secs. on-screen - $2,500
HALF SLIDE 7.25"W x 8"H; 8 secs. on-screen - $1,500
QUARTER SLIDE 7.25"W x 3.75"H; 5 secs. on-screen - $750
Sub-Total:
Tax-Deductible:

I Would Like to Make a Gift to the UCLA Department of Neurosurgery

I/We are unable to attend, but would like to make a tax-deductible donation.

I would like to make a fully tax-deductible gift of    Other $  

Grand Total:
Tax-Deductible:
 

Personal
Title:
 
* First name:  
  Middle name:
* Last name:  
  Suffix:

Joint Gift
* This is a joint gift with my spouse/partner:
 

Contact Information
* Street:  
 
U.S. Addresses  
*   City, State, Zip:
 
 
 
Non-U.S. Addresses  
  Non-U.S. City/County
  or Province/Postal Code:
 
  Country:
 
* This address is my:  
* Home telephone:    
Business telephone:  

* E-mail address:  
* This e-mail is my:  

Matching Gift

  My/my spouse's employer will match my gift.
  Company name for matching gifts:
  This company is:
Payment method:
 
Comments: