* Indicates Required Field
Arts of the Islamic World Gala
Beyond Boundaries
Friday, January 25, 2013

I am/We are pleased to support at the following level:*

Qty. Type Price Total
Principle Underwriter Table
Prioritized table for ten around the dance floor


 $50,000
Major Underwriter Table
Table for ten around the dance floor


 $25,000
Underwriter Table
Table for ten with preferred seating


 $10,000
Patron Table
Table for ten


 $5,000
Individual Underwriter Ticket


 $1,000
Individual Patron Ticket


 $500

All responses of $1,000 and above received by January 8, 2013 will be listed in the program. The fair market value of each table is $1,000 and the fair market value of each ticket is $100.

I/We cannot attend, but enclosed
is a fully tax-deductible donation of $:

 
Total Charge:  


After Fair Market Value (FMV) is applied, the remainder of your gift is tax-deductible.

I wish to waive all benefits and make this gift 100% tax-deductible.

Name (as you wish to appear on all printed materials):
Personal Information:
Title:Mr.  Mrs.  Ms.  Miss

Last Name*:


First Name*:

Corporate Contact:
Address*:
Address 2:
City*:
Zip / Postal Code*:
State / Province*:
Country:
E-Mail*:
Phone Number*:
Payment Information:
Credit Card Type*:


Expiration Date*:
Credit Card Number*:


Security Code*:
Billing Information:
Same as Personal Information
Title:Mr.  Mrs.  Ms.  Miss

Last Name*:


First Name*:
Address*:
Address 2:
City*:
Zip / Postal Code*:
State / Province*:
Country:

For information, contact Development Special Events at 713-639-7523
Email IslamicGala@mfah.org Fax713-639-7595.




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