Luxury Gala Special Sponsorship Application Name*FirstLast Email* Phone* Address Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Please Select your level of sponsorship*$15,000 Automobile Sponsorship Package$10,00 Fashion Designer Sponsorship Package$7,500 Movie Premier Sponsorship Package$5,000 Talent Sponsorship Package$3,500 Vendor Booth Sponsorship Package$1,500 Art Sponsorship Package$650 Gift Sponsorship Package D- Terms & Conditions: 1. • by check payable to Samiras Network Check #:……………………………….. • by PayPal: luxuryeventshollywood@gmail.com • by Zelle: samirashowtv@gmail.com • wire transfer to: Bank Of America Routing : 121000358 acc#:... (call us for the account number)... • By Credit Card fill out the online form Buy Online 2. The print ready artwork should be provided by the Sponsor before Jan 10, at 5pm 3. This payment authorization is for the product(s) and/or service(s) described above for the amount indicated above. 4. I, undersigned, am the legal holder and authorized signature of this credit card submitted and hereby authorize Samiras Network to charge the amount specified in this agreement in accordance to the terms and conditions stated herein. I, further acknowledge and agree that the payment made for this event is NON-REFUNDABLE and shall not be disputed, so long as it corresponds to the terms stated in this agreement. 5. I have read the terms and conditions and approve by signing:*Clear Word VerificationSubmitReset