CLEAN AIR

FUNDRAISER

WEDNESDAY
AUGUST 26, 2015 6-8 PM
NIAGARA ST
BUFFALO, NY 14207
ACQUA 2192

$20 PRESALE, $25 AT DOOR

MUSIC BY JOEY C WITH SPEEDY PARKER BAND
HORS DOEUVRES AND CASH BAR SILENT AUCTION AND BASKET RAFFLE

SPONSORSHIP LEVELS
$50 CLOUD
$250 TROPOSPHERE

$500 STRATOSPHERE
$1000 MESOPHERE

$2500 THERMOSPHERE
$5000 EXOSPHERE

NAME______________________________________________________________________________________
PHONE _____________________________ EMAIL _________________________________________________
ADDRESS __________________________________________________________________________________
CITY/STATE/ZIP _____________________________________________________________________________
# OF TICKETS ($20 EA.) __________ I CANNOT ATTEND BUT IM INCLUDING A DONATION OF ______________
PAYMENT BY

_______ CHECK

_______ CASH

_______ CREDIT CARD

CARD NUMBER ____________________________________________________________________________________

PLEASE RETURN THIS FORM TO: CLEAN AIR 52 LINWOOD AVE BUFFALO, NY 14209

CLEAN AIR
52 LINWOOD AVE
BUFFALO, NY 14209