Queens Parent Resource Center & IRIPresent

Registration Form

Thank you for joining us and supporting our 2015 Day at the Races event.

Please fill out the form below. All information, ticketing, sponsorship and

underwriting opportunities are also available for purchase online at:

www.in-res.org

□ VISA □ Mastercard □ AMEX

Attendees Name/Company:

Address

City State Zip

Telephone

Email

Payment

Amount Enclosed

$

Please make checks payable to:

Queens Parent Resource Center

All proceeds go to support both the programsof IRI and Queens Parent Resource Center.

For tickets and for more informationregarding the 2015 Day at the Races

please contact Lindsay Brienza via email atlbrienza@in-res.org or by phone 917-480-1813.

Responses can also be mailed to:Queens Parent Resource Center

112-40 Francis Lewis Blvd., Queens Village, NY 11429

CC #:

Exp. Date: CVV

Signature:

Name on Card : Saturday, September 19, 201512 PM - 6 PM

Event EmceeKaitlin Monte

News Reporter,PIX 11

Join us for a day of fundraisingat the elegant

Belmont Park Turf and Field Club(overlooking the finish line, with a panoramic view of the track)

Belmont Race Track, Elmont, NY

Saturday, September 19, 201512 PM – 6 PM

Passed Hors’ d’OuevresTuscan Tables

Open Buffet Stations

9 Exciting RacesAuctions

Crazy Hat Contest

First race kicks off at 1PM

REGISTRATIONIndividuals Ticket(s)

Yes! I/We do plan to attend.

reservation(s) at $95.00 each.

reservation(s) at $65.00 each for children ages 3-12 yrs.

SPONSORSHIP OPPORTUNITIES

□ Triple Crown $6,500

(Event Sponsor)

□ Belmont Cup $3,000

□ Kentucky Derby $2,000

□ Preakness $1,000

UNDERWRITING OPPORTUNITIES

□ Favors $2,000

□ Table Sponsorship $1,000

□ Photography & Media $500

□ Race Day Auction $200

□ Individual Support $100

□ Sorry I am unable to attend.But enclosed, please find my donation of$

E-JOURNAL

□ Gold Page (13 seconds) $600

□ Silver Page (10 seconds) $375

□ Bronze Page (7 seconds) $200

□ Copper Page (4 seconds) $75

Please email journal ads, photos or logosat 300 dpi or higher to lbrienza@in-res.org.

Registration form on reverse side.

SPONSORSHIPOPPORTUNITIES

Triple Crown $6,500(Event Sponsor)Name/Logo prominently displayed at the event, race named and displayed on the track race board, announced and listed in the race day program, paddock visit for 16 people, and photo opportunity with winning horse. Also includes two tables of 8 and 16 raffle tickets. Event sponsor will also have their logo displayed on the IRI homepage with links to their website and be mentioned in all press and social media.

Belmont Cup $3,000Name/Logo prominently displayed at the event, race named and displayed prominently on race track board, announced and listed in the race day program, 10 people to visit the winner's circle for photo opportunity with winning horse. Also includes one table of 8 and 8 raffle tickets.

Kentucky Derby $2,000Name/Logo prominently displayed at the event, race named and displayed prominently on race track board, announced and listed in the race day program, 8 people to tour the paddock for photo opportunities. Also includes one table of 8 and 6 raffle tickets.

Preakness $1,000Name/Logo prominently displayed at the event. Also includes one table of 8 and 8 raffle tickets.

UNDERWRITINGOPPORTUNITIES

Favors $2,000Name/Logo imprinted on gift items given to guests at the event. Also includes one table of 8 and 8 raffle tickets.

Table Sponsorship $1,000Make this day special for a group or IRI or QPRC individuals and their direct care providers. Your Name/Logo prominently displayed on a table or have a table named in honor of a loved one.

Photography and Media $500

Race Day Auction $200Your contribution will help us to offer a variety of goods or services in our Race Day Raffle prizes.

Individual Support $100Your contribution will allow a single individual from IRI or QPRC to enjoy an entertaining day of fun, food, entertainment and friends.

Queens Parent Resource Center & IRICordially invite you to their

16th Annual

About Queens Parent Resource Center & IRIQueens Parent Resource Center (QPRC) and IRI (formerly Independence Residences, Inc.) have affiliated their services to offer more to the individuals with developmental, visual, and other disabilities entrusted to their care. Both nonprofit human services agencies have partnered with individuals, families, and communities to emerge as leaders in their field. QPRC and IRI remain committed to providing innovative resources for independence throughout the New York metropolitan area and surrounding Long Island counties.