2015 Innovator of the Industry Donation

Innovator of the Industry
Honoring Susan Whitaker
Saturday, March 28, 2015
Donation Form
I would like to honor Susan Whitaker with a Sponsorship Level of:
____ Gold Platter- $3,000*
____ Silver Platter- $1,500*
____ Bronze Platter- $750*
____ Wall of Fame- $50*
____ I am unable to participate as a sponsor, but please accept my donation of $__________.
Tables and Tickets
____ I would like to purchase _____ seats x $150 each
____ I would like to purchase _____ tables x $ 1,000 each
Contact Information
Name:________________________________________________________________________________
Company:_____________________________________________________________________________
City, State, Zip; ________________________________________________________________________
Contact name: __________________________________ Tel: _________________________________
E-mail: _______________________________________________________________________________
Payment Information
PAYING BY CHECK, please make check payable to University of Tennessee and mail to:
Ann Fairhurst, Ph.D.
1215 Cumberland Ave, Room 110, University of Tennessee
Knoxville, TN 37996-1911
PAYING BY CREDIT CARD, please fax this completed form to (865) 974-5236 or mail this form to the above
address. Please charge my: MasterCard
Visa
Discover
Card number: ____________________________________ Exp: ___________ Security Code: ________
Name on Card: _______________________________________________________________________
Signature: ___________________________________________________________________________
*Submission Guidelines Deadline: on or before February 25, 2015
Specifications
 Acceptable file formats are .pdf (Acrobat 4.0 or later) with embedded fonts, or flattened/rasterized
Photoshop .tif files. Files should be at least 300dpi at 100% scale.
 Microsoft Word documents are not acceptable.
Required Information
 Contact name, name of your organization and your company’s logo (300 dpi).
 Personal message (if applicable)
 A digital (PDF) or hardcopy proof must be provided to e-mail or mailing address
Please note that all submissions are subject to approval and final layouts are subject to change without notice.
Send to Carol Costello at [email protected] or 865-566-8519. We will be happy to help you set-up your tribute to
Susan Whitaker in the program.