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2019 Minnesota Night Reception Sponsorship Form

December 9, 2019

6:00 – 8:00 PM

Mandalay Bay Resort and Casino – South Pacific Ballroom AB

Las Vegas, Nevada 89119

We wish to sponsor the 2019 Minnesota Night Reception.

Company Name:       Website:      

Contact Person:       Title:      

Address:      

City/State/Zip:      

Telephone:      

Email:      

Payment Options (select one):

$500 $750 $1,000

Check

Please make check payable to MSHP and submit to:

MSHP ● 13911 Ridgedale Drive, Suite 260 ● Minnetonka, MN 55305

Credit Card

Visa MasterCard

Name on credit card:      

Billing Address:      

Credit Card Number:       CVV#:      

Expiration Date:      

Signature:       Date:      

Submit form to fax number: 952-541-9684 or email to mpeterson@ (Please do not include credit card information if sending an email – call the MSHP office)

Questions call MSHP office: 952-541-9499

MSHP Tax ID#: 41-1401022

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