MATCH GALA SPONSORSHIP FORM If you are submitting a credit card payment please use a web browser other than Internet Explorer. Company/Organization Information Company/Organization Name Contact First Name Contact Last Name Phone Email Street Address Line 1 Street Address Line 2 City StatePlease select... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code Sponsorship Tiers Please choose your sponsorship levelPresenting Sponsor ($20,000)Equity Champion ($10,000)Asset Builder ($5,000)Goals Supporter ($1,000)Midas Amplifier ($500) Payment Information Payment MethodCredit CardCheckSend Me An Invoice Name on Card Billing Email Card Number MM YY Code Please make checks payable to: The Midas CollaborativeMail your payments to:2 Oliver St., Suite 802Boston, MA 02109 Contact Information
