Sponsorship:	No Sponsorship Sterling Heart Table Sponsor ($2,500) Golden Heart Sponsor ($5,000) Platinum Heart Sponsor ($10,000) Choose one sponsorship item
Dinner Ticket:	No Dinner Tickets 1 Star Dinner Ticket ($250) 2 Star Dinner Tickets ($500) 3 Star Dinner Tickets ($750) 4 Star Dinner Tickets ($1000) 1 Super Star Dinner Ticket ($500) 2 Super Star Dinner Tickets ($1000) 3 Super Star Dinner Tickets ($1500) 4 Super Star Dinner Tickets ($2000) Choose one dinner ticket item
Special Drawing:	No Special Drawing tickets 1 Special Drawing ticket ($25) 5 Special Drawing tickets ($100) 10 Special Drawing tickets ($200) 15 Special Drawing tickets ($300) 20 Special Drawing tickets ($400) Choose one special drawing item
Order Total:
First Name:	Placed under this name at the Front Desk of the event:    Last Name:
Address:	billing address for this credit card
City:	State: Zip:    Country:
Company:	(if applicable)
Phone:	Fax:
Email:

Please note: Address listed above must be the billing address for this credit card. 

	Preview the AMAZING Prizes

We accept MC, VISA and American Express Cards
Sorry, we can not accept Debit cards

Your transaction will be processed through a SECURE SERVER.
You will be sent an e-mail confirmation upon authorization of your credit card.

---

The Cancer Support Community Greater Miami is a non-profit corporation registered and licensed by the State of Florida to solicit for donations. Our Solicitation Registration Number: SC-10286. A COPY OF THE OFFICIAL REGISTRATION AND FINANCIAL INFORMATION MAY BE OBTAINED FROM THE DIVISION OF CONSUMER SERVICES BY CALLING TOLL-FREE WITHIN THE STATE 800-435-7352. REGISTRATION DOES NOT IMPLY ENDORSEMENT, APPROVAL, OR RECOMMENDATION BY THE STATE.