MDA Muscle Team® Boston
Individual Tickets Commitment Form

The cost of one ticket is $400 and allows full access to the event
(does not include the VIP reception)

# of Tickets @ $400.00 =

Yes, I would like to become a sponsor of the MDA Muscle Team® Boston. I understand       that my sponsorship will be confirmed upon receipt of this signed form and payment.
Company Name:
Contact Name:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Enclosed is my check for $ payable to the Muscular Dystrophy Association (MDA)
Please bill my:    Discover    MasterCard    Visa    AMEX
Account Number:	Expiration Date:
Signature:	________________________________________________________
Please fill out this form, print it and sign it. Fax to: 617.368.9115 or mail to: Muscle Team® Boston, c/o MDA 31 Milk Street, Suite 920 Boston, MA 02109
To make reservations by phone: 617-368-9155
To make reservations by email: