Rockin For A Cure Sponsorships

Online Sponsorship/Donation Form - Rockin' For A Cure

Please fill out the following information below:
*If unable to attend, but would still like to donate, please click here.
Sponsor *
Contact Full Name *

First Name Last Name
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Sponsorship Level *
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Platinum Record $ 10,000.00

Gold Record $ 7,500.00

Silver Record $ 5,000.00

Bronze Record $ 2,500.00

Classic Vinyl $ 1,000.00

Individual Tickets $ 150.00

Quantity

Total $ 0.00

You will be taken to PayPal’s secure transaction processing page to complete your donation and provided two options:

(1) You can log into your PayPal account (if you have one) to make payment using a credit card or account that you have already set up in PayPal, or..

(2) Pay using a credit card without logging into PayPal.

Should be Empty:

Online Sponsorship/Donation Form - Rockin' For A Cure