EFTA01205221.pdf

NU Origins — PROJECT ARIZONA STATE UNIVERSITY ORIGINS PROJECT 5th Anniversary Gala Dinner Registration Form itsu Origins April 4, 2014 I 6:30pm I Desert Botanical Garden Gala Dinner Registration FORM Company Contact Name Address Daytime Phone Number Fax Number Email Address Origins Project (OP) OP Premier OP Major OP Circle OP Individual Sponsor (one) Sponsor Sponsor Leadership Ticket Sponsor Payment Amount $25,000 $10,000 $5,000 $2,000 $150 Fair Market Value $ 6,520 $1,520 $1,370 $1,015 $95 it of tickets I would like to sponsor Premier ____Major circle Leadersh Total Enclosed (check your selection) $25,000 ___$10,000 __$5,000 _$2000 Reserve Ticket(s) / seat(s) under the name oh Payment may be made by check or credit card. Please make checks payable to the MU FOUNDATION. J Check Enclosed CI MasterCard U Visa J American Express CI Discover Credit Card Number: Expiration Date: Name on Card: Signature [Mark one] Company Card Personal Credit Card Return form with Payment to Cynthia Schulze MU Origins Project Old Main,Suite 105, 400 East Tyler Mall Box 871902, Tempe, AZ 85287-1902 Alifunds will be deposited with the ASU Foundation for A New American University, a separate nonprofit organization that exists to supportArizona State University (ASU). Gifts in support ofASU are subject tofoundation policies andfees. Due to thefair market value ofbenefits received, onlypayments in excess of market value may be considered a charitable contribution. Please consult your tax advisor regarding the deductibility ofcharitable contributions 30004641 EFTA01205221