Your Name:

Address:

City, State, Zip:

Phone:

Fax:

E-mail:

Please contact me about making the following reservation and/or contribution:

Summa Cum Laude Sponsor: $10,000
Magna Cum Laude Sponsor: $5,000
Cum Laude Sponsor: $1,800
Reception & Celebration: $175 each x Select one 1 2 3 4 5 6 7 8 9 10
University Faculty & Staff: $50 each x Select one 1 2
Unable to attend but please contact me regarding contribution.

Founders Day Table List

Please list up to a maximum of ten guests to be seated at your table, including yourself:

*We ask all table sponsors donate two seats to Park University students.

Please advise us if you have have special dietary or other physical needs: