Payment

Payment Name(s) (as you wish to be listed in all printed materials) Address City/State/Zip Phone Email O Enclosed is a check for $ O Please charge $ to my: 0 MasterCard 0 Visa Card # Exp. Date: Signature O I/We are unable to attend. Enclosed is a contribution of $ Please make your check payable to The Washington Institute, and mail to 1828 L Street NW Suite 1050, Washington, DC 20036, or register online at hnpihruww.washingtonirastitute.org/StatesmanRSVP. The Washington Institute is a 501(cX3)ontanimtion. Your contribution, less $250 per person attending, is tax deductible by law (See htm://washin.st/ SSADInal). For more information, please contact Jacqui Schein at EFTA00309600 wish to participate in the Washington Institute for Near East Policy's Scholar Statesman Award Dinner at the following lam!: O President's Table • $100,000 Includes premier seating; two tables (twenty reservations); private reception with photo opportunity; senior VIP at table; opportunity to travel to the Middle East with the Institute; invitation to private briefing; and recognition in the event program. O Secretary of State's Table • $50,000 Includes premier seating; one table (ten reservations); private reception with photo opportunity; senior VIP at table; opportunity to travel to the Middle East with the Institute; invitation to private briefing; and recognition in the event program. O Ambassador's Table • $25,000 Includes one table (ten reservations); private reception with photo opportunity; invitation to exclusive Washington, D.C., one-day events (past events have been held at the Pentagon, National Counter Terrorism Center, Treasury, and Middle East embassies); and recognition in the event program. O Diplomat's Table • $10,000 Includes one table (eight reservations); invitations to monthly conference calls and regional events with Washington Institute senior fellows; and recognition in the event program. O Tickets • $1,000 each Continued) EFTA00309601