Benefit Poker Night Sponsorship Form

"*" indicates required fields

Sponsorship Levels*

$1,000 High Roller sponsor

$500 Full House sponsor

$250 Table sponsor

I cannot sponsor but would like to make a tax-deductible gift

Quantity*

Gift Amount*

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Total