Eagle Star Awards Gala 2010

American-Israel Chamber of Commerce, Southeast Region
2010 Eagle Star Awards Gala
Registration Form

Please complete and print this form and mail mail with your check to:

American-Israel Chamber of Commerce, Southeast Region
400 Northridge Road, Suite 250
Atlanta, Georgia 30350
(404) 843-1416

2010 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

$85.00

$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:

For ticket purchase/non tax deductible contribution please make your check payable to American-Israel Chamber of Commerce, SE Region

* - Please make your Tax Deductible ticket purchase ($60 eligable for deuction)/ contribution payable to the American Israel Educational Institute.

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