Super Heroes DONATION FORM PAYMENT OPTIONS Have a Heart for Children Thursday February 8, 2018 11:30 a.m. Social ● 12:00 p.m. Luncheon Drury Plaza Conference Center Cape Girardeau, MO  Business/Individual Name _____________________________________________ Address ____________________________________________________________ Email ______________________________________________________________ Phone ______________________________________________________________ This gift is in honor of _________________________________________________ DONATION FORM (Please Print Clearly) I/We do not wish to be recognized. MASTERS OF THE UNIVERSE $2,000 Four Tables of Ten to event if requested Your Organization Name/Logo prominent placement and recognition at event Appropriate recognition on CCC Foundation website LEAGUE OF EXTRAORDINARY GENTLEMEN & LADIES $1,000 Two Tables of Ten to event if requested SUPER HERO $750 Table of Ten to event if requested Superwoman/MAN $500 Table of Ten to event if requested Your Organization Name/Logo prominent placement and recognition at event Appropriate recognition on CCC Foundation website MARVEL Sponsor $250 Event support recognition Recognition on CCC Foundation website SUPERFRIEND Table Sponsor $200 I would like to sponsor a table of ten reserved for me and my friends OTHER $ ____________ Yes, I/we would be happy to support our children at the level selected. PAYMENT OPTIONS CHECK enclosed payable to Community Counseling Center Foundation CREDIT CARD Visa Discover Master Card American Express Exp. Date ______________ Security Code _____________ Credit Card # _______________________________________________ Amount to be charged $ _________________ Name as it appears on the card _______________________________________________________________________ Please accept our sincere appreciation for your generous support! Community Counseling Center Foundation 402 S Silver Springs RD Cape Girardeau, MO 63703 mburton@cccntr.com  (573)332-2795