AAO Corporate Partner Pledge Form

Yes, count us in. We wish to become an AAOF Corporate Partner.

Please bill us at the following level, quarterly, over five years:

Pledge Type:

Platinum Corporate Partner ($500,000)

Gold Corporate Partner ($250,000)

Silver Corporate Partner ($200,000)

Ambassador Corporate Partner ($150,000)

Founder ($100,000)

Fellow ($50,000)

Regent ($25,000)

Mentor ($17,500)

Benefactor ($10,000)

Patron ($7,500)

Supporter ($5,000)

Name of Company:

Contact Person:

Address (Line 1):

Address (Line 2):

City, State, Zip:

Phone:

Fax:

E-mail:

Date:

mm/dd/yy

PLEASE MAKE ONE OF THE FOLLOWING TWO DESIGNATIONS:

Select One:

Please restrict my gift solely to the Endowment Fund

You may use my gift for orthodontic education and operational expenses at the discretion of the AAO Foundation Board of Directors

Comments:

(The AAOF is a 501(c)(3) organization, as defined by the IRS, and gifts to it are tax deductable to the extent allowed by the law.)