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Please complete the following, and return to: Dorothy Gandy, Griffin Hospital Communications & Public Affairs, 130 Division Street, Derby, CT 06418 |
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- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - __AD Reservation (to D.Gandy) ___Ticket Reservation (to N. Valentine) _____Individual Ticket $40 _____ Table of Ten $400 Name ___________________________________________________________________________ Title _____________________________________________________________________________ Company _________________________________________________________________________ Address __________________________________________________________________________ City _______________________________________________ State _________ Zip _____________ Email_____________________________________________________________________________ Phone (_____) ______________________ Fax ( _____ ) ___________________ Enclosed: check for $_____________________ Ad Copy ___________________________________ (Make checks payable to: Griffin Hospital/Valley Breast Health Care Fund (GHVBHCF) Deadline for advertising space is September 8, 2008 |
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