The 2011 event will be November 16-17 at the Galleria at the San Francisco Design Center, 101 Henry Adams Street.

RESERVATION FORM

                     DIFFA's
        DINING BY DESIGN
             San Francisco 2011

               RESERVATION FORM

Name *

First

Last

Contact Name

Name as you wish it
to appear in print

Address *

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Daytime Phone *

Cell Phone *

Email *

TABLE SPONSORSHIPS

Platinum Circle -- $20,000+

Design & Host

Table host only (Please match with a table designer)

Gold Circle -- $10,000

Design & Host

Table host only (Please match with a table designer)

Silver Circle -- $5,000

Design & Host

Table host only (Please match with a table designer)

Design Only -- $500

Please match with a table sponsor (Designer and Sponsor matches based on availability.)

Club-level Community Table -- ($350 per seat)

seats x $350

Donate

I can't attend, but my contribution in the amount of $ is enclosed.

(20% non-refundable deposit required to confirm table sponsorship)

DIFFA's
DINING BY DESIGN
San Francisco 2011

140 Laguna Street, San Francisco, CA 94102

Please make checks payable to DIFFA. DIFFA federal tax ID: 133224150.
DIFFA values the gala dinner at $150 per person and the preview party at $35 per person.
($1,500 per table, plus $35 for each TH&T ticket).
Any contribution in excess of those values is tax deductible.
Full payment is due within 30 days of commitment or by Nov. 2, 2011, which ever is first. All sales final.

Payment

Check

Visa

MasterCard

American Express

Card #

Exp. Date

(MM/YY)

Code

Thank you for your generous support of DIFFA, and the
UCSF Positive Health Program at San Francisco General Hospital.