Tax ID: 59-3527607

Showcasing the Talents & Heritage of World Kannadigas «±Àé PÀ£ÀßrUÀgÀ ¥Àæw¨sÉ ªÀÄvÀÄÛ ¥ÀgÀA¥ÀgÉ0iÀÄ ¥ÀæzÀ±Àð£À

Donor/Pledge Form

Name:

Title Last First MI

Spouse:

Address:

City: State: Zip:

E-mail: Phone: Fax:

Donors/Pledge Category (Donations may be Partially tax deductible)
Donor Category / Amt. / Complimentary Benefits Include
(Check Box at the bottom) / Check Encl./Bill my card ($..) / Amount
Pledged ($...)
 / Kannada Mitra / $600 / Registration for 2
 / Kannada Datha / $1,100 / Registration for 4
 / Kannada Kanda / $1,500 / Registration for 4 and Half page B/W ad in Souvenir
 / Kannada Rakshaka / $2,100 / Registration for 4;1 Free Business Forum ticket and Half page B/W ad in Souvenir
 / Kannada Bandhu / $3,000 / Registration for 4; One room for 3 nights; 1 Free Business Forum ticket and Full page B/W ad in Souvenir
 / Kannada Premi / $5,000 / Registration for 4; One room for 3 nights; 2 Free Business Forum ticket or 2 Free CME ticket; Full page Colorad in Souvenir and Stage Recognition
 / Kannada Kasthuri / $10,000 / Registration for 4;One family suite for 3 nights; 2 Free Business Forum ticket; 2 Free CME ticket; Full page Color ad in Souvenir; Stage Recognition and Limo transportation to and from airport
Payment Method
Donation Mailing address:
AKKA WKC 2008
319 N. Weber Rd. PMB #411
Bolingbrook, IL60490
Fax:(267) 960-5427
Email:
Contact Information:
Kajekar Ramachandra (847) 438-3550
Devangi Sreekanth (708) 481-1775
Shekar Sastry (615) 377-8888
Jayanthi Mittur (630) 497-8872 / By Check:
Payable to: “AKKA WKC 2008 Conference” Amt: $______
By Credit Card: CCType: Amex Visa MCDiscover
Card Holder Name: ______
Card Holder Address (If different): ______
Credit Card Number: ______
Exp Date: ______Amount Authorized: $______
Signature: _______Date: ______
For Official Use only :
Reg. Entered Room Booked Ad Placed / Complimentary Benefits: (Choose appropriate box ):  Call me
Book Hotel Room for me  I will book hotel myself  Register me