Eagle Star Awards Gala 2009

American-Israel Chamber of Commerce, Southeast Region
2009 Eagle Star Awards Gala
Registration Form

Please complete and print this form, including your credit card information or
a check payable to American-Israel Chamber of Commerce, and mail or fax to:

American-Israel Chamber of Commerce, Southeast Region
1150 Lake Hearn Drive, Suite 130
Atlanta, Georgia 30342
(404) 843-1416

If you choose to pay online, you still need to send us the completed form to register
(without the credit card information)

To Purchase Tickets Online Click Here

To Purchase a Table Click Here

To Make an Online Tax Deductible Contribution Click Here

For Online Sponsorship Click Here

2009 Eagle Star Awards Gala Registration Form

First Name:
(as it will appear on your name badge)

Last Name:

Title:

Company:

Address:

City:

State:

Zip:

Telephone:

Fax:

Email Address:

Registration Fee (Check all applicable boxes)

Please select here:

Price

Quantity

Total

Purchase Ticket

$75.00

$180 Contribution (one ticket) *

$180.00

$360 Contribution (two tickets) *

$360.00

$540 Contribution (three tickets) *

$540.00

I would like to make a contribution to support the work of the American Israel Educational Institute *

$ ______

I would like to be a sponsor

$ ______

Total amount for payment:

* - Please make your Tax Deductible contribution payable to the American Israel Educational Institute.

Accepted Methods of Payment: Visa MasterCard American Express Discover Check (Mail only)
Credit Card Number:	Expiration Date:
Cardholder's Name (as it appears on card):
If you are paying online, please state "Paid Online" in place of the credit card number * - Please make your Tax Deductible contribution payable to the American Israel Educational Institute.
Signature: ________________________________________________________________
Cancellation/Substitutions If you need to cancel your registration or substitute someone in your place, please notify Shelley Samach at (404) 843-9426 or aiccse@aiccse.org