RSVP Form
HOSPAC Special Regional Leadership Reception

July 24, 2008
Grand Hyatt on the Riverwalk in San Antonio
Yes! I will attend the July 24 Special Leadership Reception.*

No, I cannot attend the Special Leadership Reception, but would like to be recognized as a 2008 Leadership Level member.

I have already made my 2008 contribution of
$  on .

I am making my 2008 contribution:

Online
Via secure fax (Complete this form and fax to 512/692-2825.)
By contacting HOSPAC (lkepple@tha.org or 512/465-1047)

I have not yet made my 2008 contribution, but I would like to pledge my contribution to the following level:

$50 - Friend
$100 - Century Club
$350 - Capitol Club
$500 - Chairman's Club*
$1,000 - Millennium Leaders*
$1,500 - President's Council*
$2,000 - Ambassadors*
Other

* Please provide the following required information:

* Please list my name on the recognition panels as follows:       
*Title:          
*Hospital/Business:
*City:
*Work Phone:  -   -   EXT 
*E-mail:

Please list guest names as you would like them to appear on their name badges:

Guest #1:
Name:  
Title:
Organization:

Guest #2:
Name:  
Title:
Organization:

Guest #3:
Name:  
Title:
Organization:

Guest #4:
Name:  
Title:
Organization:


* This information is required, but will be kept confidential.

Please direct inquiries to Lisa Kepple at 512/465-1047 or lkepple@tha.org.