Albany, New York

12210

information@

albanyinstitute.org

2004 Museum Ball

 & Contemporary Art Auction

March 27, 2004

Response Form

Please complete the following form, print it and send it along with your contribution to:

Albany Institute of History & Art

External Relations Division

125 Washington Avenue

Albany, NY 12210

For questions, information, to become an AIHA member or to charge your Museum Ball tickets by phone, please contact the External Relations Division at 518-463-4478.

Name (s) __________________________________________

Address___________________________________________

City, State, Zip_____________________________________

Daytime Phone_____________________________________

Please reserve_____Benefactor ticket(s) at $500 each*

Please reserve_____Patron ticket(s) at $250 each*

Please reserve_____AIHA Member ticket(s) at $150 each

Please reserve_____Non-Member ticket(s) at $200 each

Please reserve_____Junior ticket(s) (<35 years) at $125 each

(Please note that $75 of each ticket represents the fair market value of goods and services and the remaining portion is tax-deductible.)

q Enclosed is a check or money order in the amount of  $_________ made payable to:

 Albany Institute of History & Art

OR

Expiration Date:__________________________

Signature:____________________________________________

The Marriott is holding a block of rooms for Museum Ball guests at a special reduced rate.  If interested, please call the Marriott at (800) 443-8952 for the $89 AIHA rate for March 27^th.

Seating Preference:

_____I/We would like to reserve a table of 10 including the following guests.

_____I/We would like to be seated with the following guests.

Name ______________________________________________

Name ______________________________________________

Name ______________________________________________

Name ______________________________________________

Name ______________________________________________

Name ______________________________________________

Name _____________________________________________

Name _____________________________________________

______I/We prefer to be seated away from the band.

Dietary Restrictions:_______________________________