PSR-LA 2008 Annual Gala Dinner Registration

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Sunday, June 8
Fairmont Miramar Hotel
Santa Monica, CA

6pm Reception
7pm Dinner & Award Program
Cocktail Attire

Starlight Ballroom
Fairmont Miramar Hotel
101 Wilshire Boulevard
Santa Monica, California 90401

Enter on Ocean Avenue only
Valet parking is available for $15.40

View invitation (PDF)
Read our press release (PDF)

honorees

Dr. James Yamazaki

Lawrence Bender

Joseph Cirincione

Dr. Hans Blix


Socially Responsible Medicine Award	Socially Responsible Media Award	Founders Award	Peacemaker Award

special musical guest

Gustavo Santaolalla

Grammy and Oscar Award-Winning film composer and producer, Gustavo Santaolalla’s filmography includes Babel (2006), Brokeback Mountain (2005), and The Motorcycle Diaries (2004). He pioneered the fusion of rock and Latin American folk starting in the late 1960s with his own music, and was instrumental in the development of Rock En Español, producing artists such as Molotov, Café Tacuba, Julieta Venegas, and Juanes.

Yes, I want to help PSR-LA create a safer, healthier world!

To become a sponsor, buy tickets, or place a congratulatory message in the tribute book, use the on-line form below, or download a printable version of the form (PDF)

Nobel Prize Underwriter $15,000
Two tables of ten at the event (most preferred seating) •Twenty tickets to the VIP pre-reception • Full page ad in the Tribute Book • Listing as a Nobel Prize Underwriter Sponsor in all printed materials • Special recognition during the event program and in press releases • Recognition in Prescription for Action, PSR-LA’s newsletter

Peacemaker Sponsor $10,000
One table of ten at the event (preferred seating) • Ten tickets to the VIP pre-reception • Full-page ad in the Tribute Book • Listing as a Peacemaker Sponsor in all printed materials • Special recognition during the event program and in press releases • Recognition in Prescription for Action, PSR-LA’s newsletter

Environmental Health Champion $5,000
One table of ten at the event • Ten tickets to the VIP pre-reception • Full-page ad in the Tribute Book • Listing as an Environmental Health Champion in all printed materials • Special recognition during the event program and in press releases • Recognition in Prescription for Action, PSR-LA’s newsletter

Healthy Communities Champion $3,000
One table of ten at the event • Listing as a Healthy Communities Champion in all printed materials • Recognition in Prescription for Action, PSR-LA’s newsletter

Table Captain $2,250
Sell or purchase a table of 10 tickets at $225 each for a total of $2,250 • Listing as a Table Captain in all printed materials • Recognition in Prescription for Action, PSR-LA’s newsletter

Individual Tickets

Individual Tickets @ $250 each

Individual Tickets for groups of two or more: $225 each

Individual Ticket(s) and VIP Reception: $350 each


	I / We request vegetarian meal(s). (Note: We will only be able to provide vegetarian meals to guests who request in advance.)


	I would like to sponsor tickets for medical students @ $225 each


	I/We are unable to participate, but wish to make a contribution of $

Sponsor Space in our 2008 Annual Gala Program


	LOCATION


	AMOUNT


	DIMENSIONS

Back Cover

$3,000

7 1/2” wide x 10” high

Inside Cover(s)

$1,500

7 1/2” wide x 10” high

Full Page

$750

7 1/2” wide x 10” high

Half Page

$400

7 1/2” wide x 5” high

Quarter Page

$200

3 3/4” wide x 5” high

Business Card

$150

3 3/4” wide x 2” high

Name Listing

$100


	Please submit ads as black and white artwork. The size listed above is the live space for each ad. We encourage artwork to be sent on a Mac formatted or Mac compatible disk in Quark Xpress, Adobe Illustrator or Adobe Photoshop. PDF files may also be accepted with a 300 dpi resolution. Be sure to include all screen and printer fonts and placed artwork for your ads. We can also accept camera-ready (133 line screen) hard copy of your artwork. If your artwork is submitted digitally, please include a laser print of your ad for reference. We will assist you in the preparation of your ad if necessary. Please provide copy and we will typeset your message. *Please call Denise Duffield at (213) 689-9170 if you would like to submit an ad or message.* Please send or e-mail your ad to

Download a printable version of this form (PDF)