2027 Casino Night Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Viva_Lost_Wages_Sponsorship_Flyer Name *FirstLastCompany or Organization NameAddress *Address Line 1City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail * Authorize.Net Choose Tickets Sponsorships High Roller Sponsor – $1,500 Reserved VIP table with premium champagne liquor service (one bottle and setups included) Premier logo placement on event signage, program, and marketing materials Recognition during opening remarks and prize announcements Option to display company banner at event entrance 8 event tickets (includes food, drinks, and an additional $1,000 casino cash) Featured website promotion Royal Flush Sponsor – $1,000 Reserved VIP table Prominent logo on signage and event program Recognition at the prize announcements 6 event tickets (includes food, drinks, and additional $500 casino cash) Website promotion Luck 7 Table Sponsor – $500 Logo displayed on a gaming table and in event program 4 event tickets (includes food, drinks, and casino cash) Website promotion Choose your sponsorship *High Roller Sponsor – $1,500.00Royal Flush Sponsor – $1,000.00Lucky 7 Table Sponsor – $500.00Event TicketsPrice: $50.000123456789101112131415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100Includes: Vegas-style buffet 2 Drink Tickets $1,500 Casino Cash 20 + Casino Tables & MORE!Secure online payment processing fee 4%Price: $0.00Total Price Order Summary Item Quantity Qty Total There are no products selected. Choose your sponsorship – High Roller Sponsor1$1,500.00Choose your sponsorship – Royal Flush Sponsor1$1,000.00Choose your sponsorship – Lucky 7 Table Sponsor1$500.00Event Tickets0$0.00Secure online payment processing fee 4%1$0.00SubtotalTotal$0.00 $0.00Payment Method *Credit CardCheckAuthorize.Net *Card NumberMM123456789101112Expiration/YY2627282930313233343536Security CodePaying by Check? Please make checks payable to: Southeast Regional LEPC and in the memo line list event ‘Casino Night’ Fundraiser Check NumberIf you don’t have a check number yet, please attach the invoice from your confirmation email if you plan on delivering it in person. Thank you!*** Tickets will be available at check-in *** Submit