2004 AAPD Leadership Gala
CORPORATE PLEDGE FORM

Company Name:________________________________________________
(please print name as it should appear in the awards program and related materials)

Contact Name:__________________________________________________

Title:__________________________________________________________

Address:_______________________________________________________

City:______________________________ State:_______ Zip:____________

Telephone:_________________________Fax:________________________

Email:_________________________________________________________

YES! We want to support the third-annual AAPD Leadership Gala at the Washington Hilton and Towers, Washington, DC, on March 16, 2004.

______$75,000 Corporate Chairmanship and Lead Sponsor

______ $50,000 Platinum Sponsor

______ $25,000 Gold Sponsor

______ $10,000 Silver Sponsor

______ $ 5,000 Bronze Sponsor

______ $ 2,500 Benefactor

______ $ 1,000 Supporter

______ $ 500 Friend

______ $_______ Contribution

Please fax this form to 703-442-8336 and mail donations to:
2004 AAPD Leadership Gala, c/o Hayes & Associates
1320 Old Chain Bridge Road, Suite 330
McLean, VA 22101

Checks should be made payable to:
AAPD