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* Indicates Required Field
The Rienzi Society
Tuesday, January 15, 2013
I/We accept the kind invitation to join
The Rienzi Society
.
Annual Dues:
*
Qty.
Type
Price
Total
Couple
Fair Market Value $200
$5,000
Individual
Fair Market Value $100
$2,500
I am/We are unable to join
The Rienzi Society
,
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
*
:
Address
*
:
Address 2:
City
*
:
Zip / Postal Code
*
:
State / Province
*
:
Country:
E-Mail
*
:
Phone Number
*
:
Payment Information:
Credit Card Type
*
:
Visa
Master Card
American Express
Discover
Expiration Date
*
:
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
01
02
03
04
05
06
07
08
09
10
11
12
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:
After your gift is received, formal invitations will be mailed. For additional information, call Development Special Events at 713.639.7523 or email
RienziSociety@mfah.org
.
