LHRC Holiday Benefit Gala

Holiday Benefit Gala, 2004
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The LHRC is excited to present our second annual Holiday Gala, featuring Suede.

Saturday, December 11th at the San Francisco Jewish Community Center
Benefiting the Lesbian Health Research Center

Complete this secure online form and click Submit. Or, If paying by check, print it out and mail to Stacey Carter - Lesbian Health Research Center,
          3333 California St, Suite 340, San Francisco, CA 94118.
If paying by check, please make your check out to: UCSF Foundation
(put LHRC in memo section).

Tickets:
6:30 pm - 11:30 pm
Click on down arrow to select the number of tickets at $150.

Sponsor Opportunities:

$2,500 - Amber Table Captain - 10 tickets

$1,000 - Jade Sponsor - 4 tickets

$ 500 - Lapis Sponsor - 2 tickets

$ 250 – Amethyst - Individual Ticket

Dinner Menu
Select your option for food: roasted chicken   Sea bass   Eggplant Parmesan
If purchasing multiple tickets, please indicate the number of each food option:
   chicken:     fish:     vegetarian:
If purchasing multiple tickets, please list the names of others attending:

If you do not know who else will be using your tickets or if a change occurs, please email Stacey Carter at scarter1@itsa.ucsf.edu with the information. Include your name, # of tickets, and the name changes. Otherwise the tickets will all be under your name at the door. If your group is not arriving together this may cause a slight delay.
Table captain (optional):
Singles Table: 'These tables are specially seated with fellow singles.

I am not planning to attend the benefit. Please designate my ticket for use by a volunteer. (Your entire donation will be tax deductible).

Organization:

Name, exactly as it appears on credit card, if charging:

First Name

Middle Name or Initial

Last Name

Additional Donation Please indicate amount of additional donation

Total Please indicate total amount.

Check    Visa    MasterCard    American Express

Credit Card #:
Expiration Date:

Street Address

Address (cont.)

City

State/Province Zip Code:

Phone

E-mail

Please print this page as your receipt before hitting the Submit button.

The LHRC is excited to present our second annual Holiday Gala, featuring Suede. Saturday, December 11th at the San Francisco Jewish Community Center Benefiting the Lesbian Health Research Center

Complete this secure online form and click Submit. Or, If paying by check, print it out and mail to Stacey Carter - Lesbian Health Research Center, 3333 California St, Suite 340, San Francisco, CA 94118. If paying by check, please make your check out to: UCSF Foundation (put LHRC in memo section).
Tickets: 6:30 pm - 11:30 pm Click on down arrow to select the number of tickets at $150.
	Sponsor Opportunities:
	$2,500 - Amber Table Captain - 10 tickets
	$1,000 - Jade Sponsor - 4 tickets
	$ 500 - Lapis Sponsor - 2 tickets
	$ 250 – Amethyst - Individual Ticket

Dinner Menu Select your option for food: roasted chicken Sea bass Eggplant Parmesan If purchasing multiple tickets, please indicate the number of each food option: chicken: fish: vegetarian: If purchasing multiple tickets, please list the names of others attending: If you do not know who else will be using your tickets or if a change occurs, please email Stacey Carter at scarter1@itsa.ucsf.edu with the information. Include your name, # of tickets, and the name changes. Otherwise the tickets will all be under your name at the door. If your group is not arriving together this may cause a slight delay. Table captain (optional): Singles Table: 'These tables are specially seated with fellow singles.
I am not planning to attend the benefit. Please designate my ticket for use by a volunteer. (Your entire donation will be tax deductible).
Organization:
Name, exactly as it appears on credit card, if charging:
First Name
Middle Name or Initial
Last Name
Additional Donation	Please indicate amount of additional donation
Total	Please indicate total amount.
	Check Visa MasterCard American Express
	Credit Card #: Expiration Date:
Street Address
Address (cont.)
City
State/Province	Zip Code:

Phone
E-mail

	Please print this page as your receipt before hitting the Submit button.