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May 3, 2016

6:30p.m. Check-in
7:00p.m. Program

Northwest Campus Auditorium, UCLA
200 De Neve Drive
Los Angeles, CA 90095

$20 for non-members; $10 for Friends members

Generously sponsored by Deborah and Bill Ryan



Required fields are indicated with an asterisk (*).
Tickets and Membership
SelectDescriptionAmount
Non-Members: $20 (not tax-deductible)
Friends Members: $10 (not tax-deductible)
Become a Friends of the Semel Institute Member: $110 ($100 tax-deductible, includes ticket)
Sub-Total:
Tax-Deductible:
Tax-deductible Gift

If you are unable to attend the event but would like to make an additional gift, please designate the amount below.

Your contribution to The Friends of the Semel Institute is greatly appreciated.

I would like to make a fully tax-deductible gift of   Other $

Grand Total:
Tax-Deductible:
 
GUEST INFORMATION

Please indicate the names and email addresses of all guests.

If you are bringing more than two guests, please indicate additional guest names in the comments box below.

Guest 1
 Name:
 Email Address:
Guest 2
 Name:
 Email Address:

Personal
Title:
* First name:
  Middle name:
* Last name:
  Suffix:
   I am making this gift as a proxy for my organization/company, which should be recognized as the legal donor

Contact Information
* Street:
 
U.S. Addresses  
*   City, State, Zip:
Non-U.S. Addresses  
  Non-U.S. City/County
  or Province/Postal Code:
  Country:
* This address is my:
* Home telephone:
Business telephone:

* E-mail address:
* This e-mail is my:

Payment method:
 
Comments: