Charitable Foundation

Gala Reservation Form

Please fill out the form below to reserve your tickets.

If you have already reserved your tickets, you may pay the entry fee through our secure server (please select “Gala Event” from the “Program” drop-down list), or we will contact you regarding payment.

You may also fill out the form, print and mail it with a check payable to “WMMC Charitable Foundation” to:

ATTN: White Memorial Gala
WMMC Charitable Foundation
1720 Cesar E. Chavez Ave.
Los Angeles, CA, 90033

Seating is limited and based upon receipt of payment. ($210 of each ticket is tax deductible)

Reservation Information

*Required Information

Name*
Company
Address*
City*
State*	Zip*
Phone*
Fax
Email*

Please add my name to your mailing list.

Sponsorship Opportunities & Tickets

I would like to attend the Gala or be a sponsor (view sponsorship opportunities):

Sponsorships (choose one):

Platinum Sponsor - $25,000
Diamond Sponsor - $10,000
Gold Sponsor - $5,000
No Sponsorship

Tickets (choose one):

VIP Dinner Ticket - $500
Individual Dinner Ticket - $350
No Tickets

Number of Tickets

Menu Choices:

Chicken
Vegetarian

The White Memorial Medical Center Charitable Foundation is licensed by the City of Los Angeles-Police Commission Charitable Services Section to make appeals for charitable donations. If you would like to see a copy of our permit, please contact us.