Alabama Big 3 AD & TICKET RESERVATION FORM

Historically Black Colleges and Universities


Alabama Big 3

HBCU Alumni Chapters

of Metropolitan Washington, DC
Alabama A&M - Alabama State - Tuskegee

CONTRIBUTION, AD & TICKET RESERVATION FORM
(Please complete the following information)

________________________________________________________________________________
Mr./Ms./Dr./Rev. First Name MI Last Name


________________________________________________________________________________________________
Company/Organization

________________________________________________________________________________________________
Address City State Zip Code

________________________________________________________________________________________________
Telephone Fax

________________________________________________________________________________________________
Email

Please select your option(s):

□Ticket Reservation: I would like to reserve ____Dinner Ticket(s) Amount enclosed: $________________
□ $70.00 each General Admission (purchase by 03/28/07) □ $75.00 each (purchased after 3/28/07)

Guest Name(s): _____________________________________________________________________

□ Placing Ad: Please reserve the following placement Ad in the Souvenir Program Book:

□ Patron - $10 □ Business Card - $25 □ Quarter Page - $50 □Half Page - $75 □ Full Page - $175

□ Direct Contribution: I am unable to attend but would like to make a donation $_________ for the Scholarship Dinner Gala.


Signature______________________________________________ Date____________________

Please make check payable to “Alabama Big-3 HBCUs Scholarship (WTAC)”
Mail your check, ad, and completed form to: Ouida Hampton-Taylor
c/o Alabama Big 3 HBCU
109 Apple Blossom Way
Gaithersburg, Md. 20878
Souvenir ads can be electronically sent to Ouidah@erols.com NOTE: The IRS Federal Tax Exemption Determination Letter is Available Upon Request