September 5, 2010

 Purchase tickets or make a donation

HOPE FLIES

Atlanta 2010

A Fun Evening of Cocktails and Dancing to Yacht Rock Revue
On the lofty 18th floor of Terminus 200 in Buckhead

Saturday, September 11, 2010
7:30pm to midnight

All Proceeds Benefit the Foundation for Mitochondrial Medicine


PURCHASE TICKETS OR MAKE A DONATION

I (we) would like to buy tickets for the Hope Flies September event, or simply make a donation:

I would like to purchase

tickets @ $150/person.

I am unable to attend, but please accept my donation of

$25
$50
$75
$100
$250
$500
Other Amount:  $ USD

Please complete the billing information on the right.


INDIVIDUAL/CORPORATE SPONSORSHIP

I (we) would like to be an individual and/or a corporate sponsor at the following level:

Catch Ten Fireflies @ $10,000
includes 10 tickets and recognition in all printed materials

Catch Five Fireflies @ $5,000
includes 8 tickets and recognition in all printed materials

Catch Three Fireflies @ $1,500
includes 6 tickets and recognition in all printed materials

Catch One Firefly @ $1,000
includes 4 tickets and recognition in all printed materials

Patron @ $500
includes 2 tickets and recognition in all printed materials

Host @ $1,500

Maximum online donation: $10,000
Please contact us for larger donation amounts.
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 Suite 238 . One Dunwoody Park, Atlanta, Georgia 30338. Tel 1-888-448-1495. copyright 2010, Foundation for Mitochondrial Medicine