2023 EPI One in 26 Challenge
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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
SPONSORSHIP LEVELS: Presenting: $10,000 | Cake: $5,000 | Chocolate: $3,000 | Cupcake: $2,500 | Frosting: $1,500 | Cocktail: $1,500 | Entertainment: $1,500 | Sprinkle: $500
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
SPONSORSHIP LEVELS: Presenting: $5,000 | Marathon: $3,000 | Endurance: $ 2,500 | Sprint: $2,000 | Trot: $1,500 | Jog: $1,000 | Walk: $500
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
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Leadership
About Us & History
Board of Directors
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News
Publications
Our Stories
Contact Us
Diversity, Equity, Inclusion
Compliance
Epilepsy
▼
Overview
FAQs
Camp EAGR
Camp COAST
Teen Weekend
Epilepsy Education
Webinar Links
Support Groups
Scholarship
Sudden Unexpected Death in Epilepsy (SUDEP)
Resources
1 in 26 Day
Services
▼
Developmental Disabilities
▼
Overview
Self-Direction
Respite
Family Support Services
Residential
Community Habilitation
Day Habilitation
Housing Supports
Environmental Modification/Assistive Technology
Families and Children
Brain Injury and Stroke
▼
Overview
Independent Living Skills
Structured Day/Structured Evening
Environmental Modification/Assistive Technology
Community Integration Counseling
Nursing Home Transitionion & Diversion Waiver (DOH)
Get Involved
▼
Give
Fundraising Events
Volunteer
Advocacy
Calendar
Careers
▼
Overview
Job Openings
Recruiting Events
Diversity, Equity, Inclusion
Donate
2023 EPI One in 26 Challenge
Contact Us
News
Board Login
Calendar