Night Visions Sponsor Form

Yes, I want to support CVI as a NIGHT VISIONS Sponsor!

Name (as you wish it to appear in print):

SPONSORSHIP AMOUNT: $

Presenting - $25,000

Champion - $10,000

Visionary - $7,500

Believer - $5,000

Magnifier - $2,500

Host Committee Patron - $1,500

I am unable to attend but would still like to support CVI with a donation of $

*Donations matching above sponsorship levels receive sponsor benefits equal to donation level (i.e. listing, recognition).

PAYMENT METHOD:

Check enclosed (payable to the Center for the Visually Impaired)

Credit Card

Name on Card:

Card number:

Exp. Date:

Security Code or CCV:

Billing Address:

City:

State:

Zip Code:

Cell #:

Office #:

Home #:

Email:

Signature:

Date:

MM slash DD slash YYYY

The mission of the Center for the Visually Impaired is to empower people impacted by vision loss to live with independence and dignity.

This single goal guides the programs and services of the Center for the Visually Impaired (CVI), and we work in a variety of ways to achieve it.

Center for the Visually Impaired
739 W. Peachtree St., NW
Atlanta, GA 30308
(404) 875-9011