* 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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2013 The Museum of Fine Arts, Houston