Events Event 2019 Early Childhood Investor Luncheon Registration Wednesday, October 16, 11:30 AM-1:00 PM @ Omni Fort Worth Hotel Register Below ⇓ Step 1 of 3 - Choose a ticket 0% Please choose an option from belowAvailable Tickets*CHAMPIONS ($25,000 Sponsorship)ANGEL ($15,000 Sponsorship)VENTURIST ($10,000 Sponsorship)DEVELOPER ($5,000 Sponsorship)ADVOCATE ($2,500 Sponsorship)TABLE HOST ($1,250 Per Table)INDIVIDUAL ($175 Per Ticket) Contact InfomationName* First Last Company/OrganizationIf applicable, and as it should appear on printed materialsAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email* Phone*Additional Guest Information & Dietary RestrictionsAre you bringing guests?* Yes No Not Sure Enter additional Guest Names in the box below( One guest per line)First NameLast NameEmail To add more guests use the + sign next to the field.Dietary Restrictions (Each guest per row)Name of GuestRestrictionAllergiesNotes Use the + sign on the right side of the row to add multiple guests. Please list dietary restrictions, if any: (i.e., Vegetarian, Gluten-Free, Allergies, etc.) Payment OptionsHow would you like to pay?*Pay with Debit/Credit CardPay by Check (Make payable to Child Care Associates and mailed to ATTN: Development Dept., Child Care Associates, E. Belknap St., Fort Worth, TX 76111)Please Send InvoiceCredit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Total $0.00 Confirm Sponsorship Level*CHAMPIONS $25,000ANGEL $15,000.00VENTURIST $10,000.00DEVELOPER $5,000.00ADVOCATE $2,500.00Please enter the name and address (and/or e-mail) to send the invoice if different from the contact contact information entered in the previous page.CAPTCHA For more information, please contact Rattana Mao, Director of Development3000 E. Belknap St. | Fort Worth, TX 76111817-838-0055 ext. 4403 [email protected] Child Care Associates is a public charity recognized as tax-exempt by the IRS under Section 501(c)(3).Sponsorships are tax-deductible less the value of luncheon meals and services (fair market value of $75 per person).