NIAF
NIAF East Coast Gala 2012
Join us on April 12, 2012 as we celebrate our heritage in New York City

Welcome to the NIAF East Coast Gala 2012 Registration Form. Please Reserve Your Seats Today!

    Please Note:

    - Fields with a red * are Required

    - All forms are securely submitted using encryption
 
Standard Seating Gala Ticket(s) @ $400.00 each
($4,000 for a full table - seats 10)
$ 
 
Preferred Seating Gala Ticket(s) @ 600.00 each
($6,000 for a full table - seats 10)
$ 
 
Premier Seating Gala Ticket(s) @ $1,000.00 each
($10,000 for a full table - seats 10)
$ 
 
  I am unable to attend, but would like to contribute to the
NIAF Education & Scholarship Program.
$ 
 
  TOTAL REMITTED $
 

Please complete below
 
 
Salutation:  
 
First Name:  
 
Last Name:  
 
  Firm/Organization:  
 
Address:  
 
   
 
City:  
 
State Abbreviation:     example: DC
 
Zip Code:  
 
Home Phone:     example: 202-387-0600
 
Business Phone:     example: 202-387-0800
 
Email Address:     example: johndoe@aol.com
 
    Payment Method

 
Credit Card:  
 
Credit Card Number:  
 
Credit Card Expiration Month:  
 
Credit Card Expiration Year:  
 

Check this box if the credit card billing address is the same as previously entered. If not, please complete the below 

First Name * Last Name *
Street *
City * State *                Zip*      
 
   


ABOUT SSL CERTIFICATES
 
 


Follow NIAF on Facebook! Follow NIAF on Twitter! Check out NIAF on YouTube!




Advertisement





Find out more!