Reservation Card for
DeKalb Medical Society's Annual Meeting
And
Physicians' Care Clinic Benefit
Please reserve _____ seat(s) at $110 each.
(each seat includes $50 Casino Chips)
Please reserve _____ table(s) at $1,100 each.
(10 seats per table)
Please reserve $_____ extra Casino Chips
(Buy ahead discount - $100 of Casino Chips for $50)
Name: _______________________________
Phone Number :________________________
Please return payment by January 20th, 2012.
770.271.2798
P.O. Box 2048
Tucker, GA 30085
Sponsorship of the
Physicians' Care Clinic
Please consider becoming a sponsor of the Physicians' Care Clinic. Individuals/couples may want to consider Patron Membership while larger groups and companies providing goods and services to the medical profession may want to become Gold, Silver or Bronze sponsors. Sponsorship is not required for attendance. Your commitment to attend is very appreciated.
Yes, I will become a 2012 Sponsor of the DeKalb Medical Society's Physicians' Care Clinic at the following level:
______Gold ($5,000) _____ Bronze ($1,000)
______Silver ($3,000) _____ Patron ($250)
Name: ______________________________
Phone: ______________________________
The Physicians Care Clinic is operated under the aegis of the Physicians Alliance for Community Service, a 501( c )3 charitable organization established by the DeKalb Medical Society. All donations are fully tax-deductible.
