Circle of Empowerment Commitment Form

MEMBERSHIP TYPE & RECOGNITION

Please indicate if this is an INDIVIDUAL or a CORPORATE pledge.(Required)

Individual Pledge

Corporate Pledge

Please indicate how you would like this gift to be recognized. Individual Example: Mr. & Mrs. John & Jane Smith. Corporate Example: Main Street Bank & Trust(Required)

CONTACT INFORMATION

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

CIRCLE OF EMPOWERMENT ANNUAL PLEDGE AMOUNT

Please indicate your total Circle of Empowerment annual commitment below. EPI will send monthly pledge reminders and payment in full is due by the end of each calendar year.

Total Annual Commitment

GIFT ALLOCATION

Please indicate how you would like us to allocate your annual Circle of Empowerment gift.

Chocolate Ball Sponsorship

Chocolate Ball Ticket Purchase

$200 per ticket

Chocolate Ball Cash Call

Donor’s discretion.

EPI Winter Nights Sponsorship

SPONSORSHIP LEVELS: Presenting: $5,000 | Gold: $2,500 | Silver: $1,000 | Bronze: $500 | Entertainment: $2,000

EPI Summer Nights Sponsorship

SPONSORSHIP LEVELS: Presenting: $5,000 | Gold: $2,500 | Silver: $1,000 | Bronze: $500

One in 26 Challenge Sponsorship

One in 26 Challenge Registration

REGISTRATION FEES: Ages 13+: $26 | Children 3-12: $13 | Children under 3: Free

Annual Campaign Donations

Donor’s Discretion

Other:

Please use this space to enter any notes or specific requests.

Total Gift Allocation