1. 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 ____________________________________________________________
______________________________________________________________
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
 (573)