14th Anniversary Gala

Please RSVP by November 2, 2018

Table & Ticket Opportunities

Note: This form is on a secure connection. Any information you exchange with this site cannot be viewed by anyone else on the Web.

Yes, I will attend the 14th Anniversary Gala.

Please check next to your choice:

$15,000 - VIP Table for 10

$10,000 - Table for 10

$1,500* - VIP Gala Ticket
Number of VIP Tickets

$1,200** - Gala Ticket
Number of Tickets

$800*** - Gala Ticket For Physician Only
Number of Tickets

*$1,150 of each VIP ticket is tax-deductible
**$920 of each ticket is tax-deductible
***$525 of each physician ticket is tax-deductible

Sorry, I am unable to attend, please charge my credit card the following tax-deductible contribution:
$10,000 $5000 $2500 $1000 $500 $250 Other

My donation is in honor of:
Kevin Plancher, MD, MPH
Olivia Palermo
Wes Matthews Sr.
Chef Ben Bebenroth
Chef Bill Telepan
Cindy Hsu

Your charitable contribution grants patients access to cutting edge technology and trains future researchers in the field of orthopaedics. Thank you for supporting our cause that will better the quality of all lives, both young and old, and for helping us to promote excellence in medicine and education.

I would like to be a Sponsor and\or place an Ad in the 14th Anniversary Gala Journal. Certain levels include tickets to the Gala. Click Here For Advertising Rates


NOTE: There will be an additional $6.50 per ticket processing fee for online payments.
* Tickets Are Non-Refundable!


BILLING INFORMATION
Credit Card:
Cardholder Name:
Email Address:
Phone Number:
Card Number
Expiration Date
Security ID   Where's My Security ID?

BILLING ADDRESS
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country


*All reservations and special announcements will be sent via e-mail.
We will not share your email address with any party.

Please Provide the Names and Emails of all of your Guests


For more information -please call Janine Bahar at 203-869-2002 ext 403 or to e-mail ads to Janine at : jbahar@ofals.org or fax to 203-869-4040. Or mail to: Orthopaedic Foundation-2777 Summer Street, Suite 500, Stamford, CT 06905.