(DonateGalaStep1)


Step 1 Donation Information Step 2 Verification page Step 3 Credit Card Information

Chance of a Lifetime Gala Tickets
Tickets
Individual tickets include: cocktail reception, a reserved seat for dinner, participation in the silent and live auction, a seat at the musical performance and the opportunity to take part in the Fund-A-Cure program.	Individual Tickets	tickets $375.00 each (number of tickets)

Tables
Tables include ten individual tickets (up to two additional seats can be added to a table for $375 per person additional). A donor may purchase a table using a maximum of two payments (cash, check, or credit card).	$3,500.00 Level	tables $3,500.00 each (number of tables)
	$6,000.00 Level	tables $6,000.00 each (number of tables)
	$10,000.00 Level	tables $10,000.00 each (number of tables)
	$15,000.00 Level	tables $15,000.00 each (number of tables)
	$25,000.00 Level	tables $25,000.00 each (number of tables)

Additional Donation
I would also like to make a fully tax deductible donation to the JDRF at this time or I am unable to attend, but wish to make a donation.		dollars (amount of donation)
Donations of $3,500 and above will be listed in the program book. Please specify how you would like your listing to appear.	(your name)

Guest Information (names, mailing address, email address) Table sponsors will be sent a form outling your benefits and requesting guest list information. Information is requested to ease registration, not for solicitation purposes.
	Sample: Mr. and Mrs. John Smith 123 Main Street City, State Zip jsmith@aol.com
Please Note: Tickets will not be mailed. Guests will register by last name upon arrival at the event.


		= Required Fields
		Billing Information
Cardholder's Name:
		This address MUST match your credit card billing address
Billing Address 1:
Billing Address 2:
City:
State:
Zip Code:
Cardholder's Main Phone:		() - Extension:
Your E-mail Address:


If you would like an alternate way to give please call 312/670-0313. JDRF Illinois 500 North Dearborn, Suite 305 Chicago, Illinois 60654-3300