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R. S. V. P. R.S.V.P.


P lease select fro m the follo wing level s of giving: l Most Honorable Heart ($100,000 and above–table of 10)

l Ambassador of Heart ($10,000 and above–table of 10)

l Royal Heart ($50,000 and above–table of 10)

l King of Heart ($5,000 and above–2 individuals)

l Honorable Heart ($75,000 and above–table of 10)

l Ace of Heart ($10,000–2 individuals)

l Majestic Heart ($35,000 and above–table of 10)

l Queen of Heart ($3,000 and above–2 individuals)

l Noble Heart ($25,000 and above–table of 10)

l Jack of Heart ($1,500 and above–2 individuals)

l Regal Heart ($15,000 and above–table of 10)

Your contribution in excess of $165 per seat is tax-deductible.

Number of seats desired ______________________________________________________________________________________________________ I wish to pay by:

l Visa

l MasterCard

l AMEX

l Discover

l Enclosed Check

Name as it appears on card ___________________________________________________________________________________________________ Credit Card # _________________________________________________________________________________Expires__________________________ Signature __________________________________________________________________________________ SEC Code _________________________ Check enclosed $______________________________________________________________________________________________________________ (Checks are payable to American Heart Association).

My regrets are expressed with a donation of $ _____________________________________________________________________________ If you would like further information or an invitation sent to your guests, please contact Kelly Grose, (602) 414-5357 or kelly.grose@heart.org and we will gladly accommodate your request. The favor of a reply is requested by Monday, October 31, 2011


Please print your name as you wish it to appear in the Heart Ball Program. l Mr. & Mrs

l Dr. & Mrs

l Mr. & Dr.

l Dr. & Dr.

l Mr.

l Mrs.

l Ms.

Name____________________________________________________________________________________________________________________________ Address_ ________________________________________________________________________________________________________________________ City_________________________________________________________________ State __________ Zip Code__________________________________ Contact Name __________________________________________________________________________________________________________________ Contact Phone Number __________________________________________ E -mail Address:___________________________________________ I am a guest at a table hosted by: __________________________________________________________________________________________ Please list any special meal requirements:__________________________________________________________________________________ To be listed in the Heart Ball Program, please respond by Friday, October 14, 2011 I wish to be seated with: ______________________________________________________________

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Heart Ball 2011 RSVP Card