ASU Origins PROJECT

ARIZONA STATE UNIVERSITY

INSPIRING WONDER

CELEBRATING 5 YEARS OF

ASU Origins.

ORIGINS PROJECT

Sth Anniversary Gala Dinner Registration Form 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 Sponsor (one)	OP Major Sponsor	OP Circle Sponsor	OP Leadership Sponsor	Individual Ticket
Payment Amount	$15,000	$10,000	$5,000	$2,000	$150
Fair Market Value	$6,520	$1,520	$1,370	$1,015	$100

I would like to sponsor (check your selection)
[ ] Premier $15,000
[ ] Major $10,000
[ ] circle $5,000
[ ] Leadership $2,000

of tickets:

Total Enclosed:

Reserve Ticket(s) / seat(s) under the name of:

Payment may be made by check or credit card. Please make checks payable to the ASU FOUNDATION.
[ ] Check Enclosed
[ ] MasterCard
[ ] Visa
[ ] American Express
[ ] Discover

Credit Card Number:
Expiration Date:

Name on Card:
Signature

[Mark one]
Company Card
Personal Credit Card

Return form with Payment to

Cynthia Schulze
ASU Origins Project
Old Main,Suite 105, 400 East Tyler Mall
P.O. Box 871902, Tempe, AZ 85287-1902

Email: Cynthia.schulze@asu.edu
Phone: (480)965-0053
Fax: (480)965-0090

Allfunds willbe deposited with the ASU Foundation for A New American University, a separate nonprofit organization that exists to support Arizona State University (ASU). Gifts in support ofASU are subject to foundation policies andfees. Due to thefair market value of benefits received only payments in excess offer market value may be considereda charitable contribution. Please consult your tax advisor regarding the deductibility of charitable contributions