The Lackey Invitational 2022 Registration

Lackey Clinic's Gala
Sponsorship Application & Registration

Saturday, October 7, 2023
Christopher Newport University's Ferguson Center for the Arts
Peebles Theatre
(1 Avenue of the Arts, Newport News, VA 23606)

Thank you for sponsoring our Gala!

If you have any questions or any difficulty completing the form below, please contact Kim Spencer at 757-886-0608 ext. 233, kspencer@lackeyhealthcare.org

Date*

Date

Your Sponsor Name *

(Business or Individual)

Mailing Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code

Contact Person*

First NameLast Name

Please enter a contact cell phone number and email address so we can send event updates. You can unsubscribe from our texts and emails at any time.

Contact Cell Phone Number*

Contact Email Address*

Your Business Logo

Upload File

Your Business Website

Please Choose Your Sponsorship Level*

Gold Sponsorship: $10,000 or moreSilver Sponsorship: $5,000Bronze Sponsorship: $1,000

If you know who your Gala attendees will be, please enter their information below, so we can send them event updates. They can unsubscribe from our texts and emails at any time.

If you are unsure at this time who your Gala attendees will be, just skip the contact information for now, and complete the rest of the form. Then later, once you have their information, please email Teena Hicks at thicks@lackeyhealthcare.org

Gala Attendee #1 Name

First NameLast Name

Gala Attendee #1 Cell Phone Number

Gala Attendee #1 Email Address

Gala Attendee #2 Name

First NameLast Name

Gala Attendee #2 Cell Phone Number

Gala Attendee #2 Email Address

Gala Attendee #3 Name

First NameLast Name

Gala Attendee #3 Cell Phone Number

Gala Attendee #3 Email Address

Gala Attendee #4 Name

First NameLast Name

Gala Attendee #4 Cell Phone Number

Gala Attendee #4 Email Address

Gala Attendee #5 Name

First NameLast Name

Gala Attendee #5 Cell Phone Number

Gala Attendee #5 Email Address

Gala Attendee #6 Name

First NameLast Name

Gala Attendee #6 Cell Phone Number

Gala Attendee #6 Email Address

Total Cost

Payment Options*

I will pay by credit card below.I will mail a check to Lackey Clinic.

Please make check payable to Lackey Clinic.

Mail to:

Lackey Clinic
Attn: Teena Hicks
1620 Old Williamsburg Road
Yorktown, VA 23690

Payment Total

USD

Debit/Credit Card

Lackey Clinic's Gala Sponsorship Application & Registration

Debit/Credit Card

Lackey Clinic's Gala
Sponsorship Application & Registration