50th Anniversary Celebration

Name *

Organization

Email Address *

Phone Number

Would you like to: *

Purchase Individual Tickets

Sponsor the 50th Anniversary Celebration

Individual Tickets: Select number of tickets (for Sponsorships, skip and go to next question)

1 ($150)

2 ($300)

3 ($450)

4 ($600)

Sponsorship level (if purchasing individual tickets, skip to the next question)

Gold ($5,000)

Silver ($2,500)

Bronze ($1,500)

Payment Method *

Check: please make payable to Quixote Center and send to PO Box 1950 Greenbelt, MD 20678

Credit Card: please visit www.quixote.org/donate and select 50th Anniversary under designation

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