2005 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 4^th Annual AAPD Leadership Gala at the Capital Hilton in Washington, DC on March 9, 2005.

______$100,000  Lead Sponsor

______ $50,000  Platinum Sponsor

______ $25,000  Gold Sponsor

______ $10,000  Silver Sponsor

______ $5,000  Bronze Sponsor

______ $2,500  Benefactor

______ $1,000  Supporter

______ $_______ Contribution

Please fax this form to Leigh Hearne at 703-442-8336 and mail donations to:
2005 AAPD Leadership Gala
c/o Hayes & Associates
1320 Old Chain Bridge Road, Suite 330
McLean, VA 22101
Phone: 703-905-9838

Checks should be made payable to:
AAPD (Federal ID # 59-1930174)