2010 Inaugural Gala
April 22, 2010; 6 PM

Company/ Name _______________________________________________

Address _____________________________________________________

City __________________ State _____ Zip ___________

Phone _________________ Email _____________________________

Dinner Dance Tickets

* Individual please reserve ________ticket(s) at $125 each

* Table of Ten please reserve_________table(s) at $1,250 each

* I am unable to attend but would like to make a donation to M.A.N. Foundation

in the amount of $_________ for the education of seminarians.

50/50 Raffle Tickets

* Raffle Ticket please reserve ________ticket(s) at $50 each

Total Amount Enclosed: $____________

Response Deadline ~ March 22, 2009

:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

Please make checks payable to The M.A.N. Foundation or bill my
* MasterCard * Visa

I authorize The M.A.N. Foundation to charge $______________

Credit Card # _______________________________ Exp Date _________ CVC Code #__________

Billing Address ________________________________ Zip Code ________________________

Cardholders Signature ___________________________ Date ___________________________

This form may be printed and mailed with your payment to:

M.A.N. Foundation; 1121 Oyster Bay Road; Muttontown, N.Y. 11732
Thank you for your support!
All proceeds benefit the work of the M.A.N. Foundation
Phone: 516.624.9033 Fax: 516.624.9042
The M.A.N. Foundation is a 501(c) (3) nonprofit organization

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