Corporate Champion Pledging

Company Name (as you would like it to appear):*
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Platinum Plus
Price: $7,500.00 Quantity:
Platinum Plus- Pledging to donate $7,500.00 to Laney's Legacy of Hope every year for 5 years, for a total donation of $37,500.00.
Platinum
Price: $7,500.00 Quantity:
Platinum- Pledging to donate $7,500.00 to Laney's Legacy of Hope every year for 3 years, for a total donation of $22,500.00.
Diamond Deluxe
Price: $5,000.00 Quantity:
Diamond Deluxe- Pledging to donate $5,000.00 to Laney's Legacy of Hope every year for 5 years, for a total donation of $25,000.00.
Diamond
Price: $5,000.00 Quantity:
Diamond- Pledging to donate $5,000.00 to Laney's Legacy of Hope every year for 3 years, for a total donation of $15,000.00.
This online donation is going towards which year of your pledged donation*
Total
$0.00
Upload Company Logo
Accepted file types: jpg.
You can also email artwork as a JPEG to [email protected] Logo MUST be emailed by deadlines provided on fundraising pages to guarantee sponsorship level benefits can be honored.

Golden Gala Sponsorship

1 Your Info

2 Parent's Info

3 Child's Diagnosis

Your Name*
First Last
Relationship to Child*
Your Email*
Your Phone Number*
How did you find out about Laney's Legacy of Hope grant program?*

Parent/Legal Guardian's Name*
First Last
Their Email*
Their Phone Number*
Their Address*
Street Address Address Line 2 City State ZIP Code

Name of Child*
First Last
Age of Child*
Child's Date of Birth*
Date Format: MM slash DD slash YYYY
Diagnosis*
Is Child Considered High Risk (Per Physician)?*
Date Diagnosed*
Date Format: MM slash DD slash YYYY
Is Child Currently in Treatment?*
*If No, is treatment no longer an option (i.e. Hospice)?
Name of Hospital Child is Currently Treated at?*
Tell is this Child's Story:*
Has this child/family ever received assistance from Laney's Legacy of Hope in the past?*
What are the Family's Immediate Needs During this Time in their Child's Treatment? (Ex: Financial - rent/mortgage assistance, utility bills, gas cards, etc. or Services- boarding for animals, lawn mowed, etc.)*
By Typing your Name Below you are Certifying that the Provided Information is Correct to the Best of your Knowledge.*

Golden Gala Tickets

1 Your Information

2 Ticket Information

3 Table Information

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Enter Email Confirm Email

Individual Tickets $75.00 per person or purchase a Whole Table (10 tickets) for $750.00.
What type of tickets would you like to purchase?*
How many tickets (or Tables) would you like to purchase?*
Ex. Enter '2' if ordering two (2) individual tickets, or two (2) Tables (2 tables = 20 tickets total)
Special Requests (Seating Requests, Vegetarian meal, Food Allergies, etc.)
Total
$0.00

Please tell us the names of those who will be using your tickets so that we can properly check them in on the night of the event. You can share the names with us now or you can email us your list prior to the event at: [email protected]
Name
First Last
Name
First Last
Name
First Last
Name
First Last
Name
First Last
Name
First Last
Name
First Last
Name
First Last
Name
First Last
Name
First Last

Please note that after your PayPal transaction is completed your PayPal receipt (which should go to the email address provided during PayPal checkout) will be your confirmation!!

The Foundation may send you an email closer to the Golden Gala overviewing details of the event. ALL other race information and FAQs can be found on our Golden Gala webpage.

Following your ticket purchase

Individual Ticket Purchases: You will not need to bring a ticket/receipt to the event. Your table number will be given to you at the registration desk after submitting your name. ***This event is an assigned seating event. If you want to sit with friends/family we recommend purchasing a whole table or be sure to submit your seating requests in the comment space provide.***
Whole Table Ticket Purchases: If you provided the names of all the individuals sitting at your table prior to submitting the form, then you will follow the same process as the Individual Ticket Purchaser’s for the day of the event. If you were unsure who would be sitting at your table when the table purchase was made you have two options…. email [email protected] by Oct 1st with the names of the guests at your table or tell your guests that they will be under your name at the registration desk the day of the event (i.e. John Smith Guest #1, John Smith Guest #2).
Any questions about your ticket order can be directed to Jenell Wolf [email protected]

Golf Scramble Sponsorship

Name of Contributor/Company Name:*
Name of Contact Person:*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Sponsorship Agreement Level*
- Platinum Sponsor
- Gold Sponsor
- Silver Sponsor
Make an Additional Donation
Total
$0.00
Please Upload your logo or artwork here:
You can also email artwork as a JPEG to [email protected] Logo MUST be emailed 2 weeks prior to the event to guarantee sponsorship level benefits can be honored.

Golf Scramble Team Registration

1 Your Info

2 Tell Us About Your Team

3 Complete Your Payment

Your Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Enter Email Confirm Email

Your team can be up to 4 golfers. If you have a larger number of golfers, please create separate teams with a total of up to 4 golfers on each team. Please list the golfers on your team below.
Team Name*
Team Member 1
First Last
Team Member 2
First Last
Team Member 3
First Last
Team Member 4
First Last
Signature*

Paypal Fee
Total
$0.00

Please note that after your PayPal transaction is completed your PayPal receipt (which should go to the email address provided during PayPal checkout) will be your confirmation!!

The Foundation may send you an email closer to the golf scramble overviewing details of the day. ALL other golf scramble information and FAQs can be found on our Golf Scramble webpage.

Alexis Runyen

Age: 11 • Diagnosis: Stage 4 Wilm’s Tumor • Date of Diagnosis: 1/05/2017

Lexi gained her wings, July 2019, after 3 years of fighting kidney Cancer.

Throughout her battle with cancer she remained positive and lifted others up around her.

We Need Your Help!

Please consider a donation or sponsorship to help us continue our battle and help more children and families struggling with pediatric cancer.

Donate Now

Piper Irias

Age: 2 • Diagnosis: Stage 4 Neuroblastoma • Date of Diagnosis: 05/17/19

Meet Piper, a feisty, red-headed two-year-old.

This past spring, her mother noticed she was limping. She took Piper to the doctor, who then sent her to Children’s Hospital of Philadelphia (CHOP).

On May 16, 2019, the doctors at CHOP found a mass inside Piper’s belly, which was pushing down on her hip and causing the limp. On May 17, they discovered Piper has neuroblastoma, a rare cancer that accounts for 7-10% of childhood cancers. It has metastasized into her bones and other parts of her body (Stage M cancer).

Never in a million years did her mom think a limp would lead to this. At two years old, Piper is starting a long journey toward recovery.

We Need Your Help!

Please consider a donation or sponsorship to help us continue our battle and help more children and families struggling with pediatric cancer.

Donate Now

Jeremiah Reedy

Age: 2 • Diagnosis: Rhabdomyosarcoma • Date of Diagnosis: 6/20/2019

On June 7th, our three-year-old son Jeremiah Michael was diagnosed with pediatric cancer called Rhabdomyosarcoma, just two days after having exploratory surgery to see what was causing his severe stomach pain. As anyone can imagine, our world was rocked as those are words that no parent ever wants to hear. Jeremiah is an active little boy who loves dinosaurs, being silly, Paw Patrol, and his older sister. Through all of his testing and doctors appointments at Penn State Hershey Children’s Hospital, he has not once asked why he is going through all of this.

He is one strong little guy!

We Need Your Help!

Please consider a donation or sponsorship to help us continue our battle and help more children and families struggling with pediatric cancer.

Donate Now

Vincent Nowroozi

Age: 18 months old • Diagnosis: Atypical Teratoid Rhabdoid tumors (ATRT) • Date of Diagnosis: 6/19/2019

Vincent is a sweet, innocent, baby boy who, at four months old, was diagnosed with ATRT, a rare, fast-growing cancerous brain tumor.

This type of tumor is found in less than 3% of pediatric brain tumors. Vincent has been fighting for his life ever since.

You can follow along in his journey on Facebook by searching “victory 4 vincent”

We Need Your Help!

Please consider a donation or sponsorship to help us continue our battle and help more children and families struggling with pediatric cancer.

Donate Now

Xavier Ortiz

Age: 3 • Diagnosis: Nuerofibromatosis 1 • Date of Diagnosis: 05/01/16

We Need Your Help!

Please consider a donation or sponsorship to help us continue our battle and help more children and families struggling with pediatric cancer.

Donate Now

Why We Do What We Do

Laney’s Legacy of Hope Gives Back

First’s Without Her….

Four Months Without Our Angel Laney

Archives

Categories

Corporate Champion Pledging

Golden Gala Sponsorship

Golden Gala Tickets

Please note that after your PayPal transaction is completed your PayPal receipt (which should go to the email address provided during PayPal checkout) will be your confirmation!!

The Foundation may send you an email closer to the Golden Gala overviewing details of the event. ALL other race information and FAQs can be found on our Golden Gala webpage.

Following your ticket purchase

Golf Scramble Sponsorship

Golf Scramble Team Registration

Please note that after your PayPal transaction is completed your PayPal receipt (which should go to the email address provided during PayPal checkout) will be your confirmation!!

The Foundation may send you an email closer to the golf scramble overviewing details of the day. ALL other golf scramble information and FAQs can be found on our Golf Scramble webpage.

Alexis Runyen

Age: 11 • Diagnosis: Stage 4 Wilm’s Tumor • Date of Diagnosis: 1/05/2017

We Need Your Help!

Piper Irias

Age: 2 • Diagnosis: Stage 4 Neuroblastoma • Date of Diagnosis: 05/17/19

We Need Your Help!

Jeremiah Reedy

Age: 2 • Diagnosis: Rhabdomyosarcoma • Date of Diagnosis: 6/20/2019

We Need Your Help!

Vincent Nowroozi

Age: 18 months old • Diagnosis: Atypical Teratoid Rhabdoid tumors (ATRT) • Date of Diagnosis: 6/19/2019

We Need Your Help!

Xavier Ortiz

Age: 3 • Diagnosis: Nuerofibromatosis 1 • Date of Diagnosis: 05/01/16

We Need Your Help!

Why We Do What We Do

Laney’s Legacy of Hope Gives Back

First’s Without Her….

Four Months Without Our Angel Laney

Archives

Categories

Corporate Champion Pledging

Golden Gala Sponsorship

Golden Gala Tickets

**Please note that after your PayPal transaction is completed your PayPal receipt (which should go to the email address provided during PayPal checkout) will be your confirmation!!**

The Foundation may send you an email closer to the Golden Gala overviewing details of the event. ALL other race information and FAQs can be found on our Golden Gala webpage.

Following your ticket purchase

Golf Scramble Sponsorship

Golf Scramble Team Registration

**Please note that after your PayPal transaction is completed your PayPal receipt (which should go to the email address provided during PayPal checkout) will be your confirmation!!**

The Foundation may send you an email closer to the golf scramble overviewing details of the day. ALL other golf scramble information and FAQs can be found on our Golf Scramble webpage.

Alexis Runyen

Age: 11 • Diagnosis: Stage 4 Wilm’s Tumor • Date of Diagnosis: 1/05/2017

We Need Your Help!

Piper Irias

Age: 2 • Diagnosis: Stage 4 Neuroblastoma • Date of Diagnosis: 05/17/19

We Need Your Help!

Jeremiah Reedy

Age: 2 • Diagnosis: Rhabdomyosarcoma • Date of Diagnosis: 6/20/2019

We Need Your Help!

Vincent Nowroozi

Age: 18 months old • Diagnosis: Atypical Teratoid Rhabdoid tumors (ATRT) • Date of Diagnosis: 6/19/2019

We Need Your Help!

Xavier Ortiz

Age: 3 • Diagnosis: Nuerofibromatosis 1 • Date of Diagnosis: 05/01/16

We Need Your Help!

Please note that after your PayPal transaction is completed your PayPal receipt (which should go to the email address provided during PayPal checkout) will be your confirmation!!

Please note that after your PayPal transaction is completed your PayPal receipt (which should go to the email address provided during PayPal checkout) will be your confirmation!!