BD2009 Reservation Form
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Monday, November 9 • Reception 6:30PM • Dinner 7:30PM • Cipriani 42, New York
 
Dinner Reservation Form

The Benefit Dinner will honor Amgen CEO Kevin Sharer and Chevron CEO Dave O'Reilly. For reservations, please print and return this form via fax to 
(212) 338-6864 or contact Diane Sinclair at (212) 338-6860 x 217.
 
 
Please reserve _____ PLATINUM Tables(s) for $50,000
    Premium table for 10 guests and 10 tickets to VIP Reception
    Full-page advertisement, Platinum listing in Dinner Journal, website and event signage
 
Please reserve _____ GOLD Table(s) for $35,000
    Priority table for 10 guests and 4 tickets to VIP Reception
    Half-page advertisement, Gold listing in Dinner Journal, website and event signage
 
Please reserve _____ SILVER Table(s) for $25,000
    Select table for 10 guests and 2 tickets to VIP Reception
    Silver listing in Dinner Journal, website and event signage
 
Please reserve _____ BRONZE Table(s) for $15,000
    Table for 10 guests
    Bronze listing in Dinner Journal, website and event signage
 
Please reserve _____ INDIVIDUAL ticket(s) for $1,500
 
I am unable to attend, but would like to contribute $ ____________
      
    Enclosed is my check payable to American Australian Association for $ ____________
    Please invoice me for $ ____________
 
 
Please complete the following: (Your name, title & company will be listed as provided)
Name      _________________________________________________________________
Title         _________________________________________________________________
Company _________________________________________________________________
Address   _________________________________________________________________
City         _________________________________  Zip _______________ State________
Phone      _________________________________  Fax ___________________________
Email       _________________________________________________________________
 
 

 

 
 
 

 

 
 
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