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

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

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.)