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MÉLANGE GALA 2015
SPONSORSHIP REPLY FORM
Yes, I would like to sponsor the 11th annual Mélange Gala on
Saturday, November 7, 2015!
Platinum | $25,000
Silver | $5,000
Patron | $1,000
Gold | $10,000
Bronze | $2,500
Supporter | $500
Please make checks payable to Milford Regional Healthcare Foundation and mail to
14 Prospect Street, Milford, MA 01757. All sponsorships are tax-deductible to the fullest extent of the law.
Contact Name: _______________________________________________
Title: _________________________________
Name or Company (as you would like it appear on event materials): ____________________________________________
__________________________________________________________________________________________________
Street: ______________________________________________________________________________________________
City: ___________________________________________ State: _____________________Zip: _____________________
Phone: _________________________________________ Cell: _______________________________________________
Email: ______________________________________________________________________________________________
Payment enclosed
Please send an invoice
Milford Regional Healthcare Foundation
14 Prospect Street, Milford, MA 01757
foundation.milfordregional.org/Melange
Contact Kelly See at 508-422-2034
ksee@milreg.org for more information.
Hopedale
Community
House, Inc.
To have your name removed from our distribution list for future fund raising materials designed to support Milford Regional, please contact us at this same address.