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2024 Gala Honorary Committee Form
Gala Honorees: Alan Goldberg
Gala Co-Chairs: Christine and George R. Hearst III
Please return this form by April 19, 2024 to be included in the invitation.
Contact Information
Name
*
Prefix
First Name
Last Name
Suffix
Honorary Name
*
Please indicate here how you wish your name(s) to be written on the Gala invitation
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Email
*
Verify Email
*
Phone
Ticket Information
We are purchasing the following tickets:
Quantity
$500
-
Benefactor Level
0
1
2
3
4
5
6
7
8
9
10
10
$350
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Patron Level
0
1
2
3
4
5
6
7
8
9
10
10
$300
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Junior Level (ages 40 & under)
0
1
2
3
4
5
6
7
8
9
10
10
Please include any additional names attached to your tickets
Are you planning to attend the Gala?
*
Yes
No
I/We cannot attend the event but would like to make a fully-tax deductible donation to support the Albany Institute in honor of Alan Goldberg. To join Honoree Circle, donations are $100 & up per person.
$
Add 3% to my total amount to help cover the payment processing fees
