Association of Indians in America (AIA), Inc.
Metropolitan Washington Chapter
AIA CONTRIBUTION RESPONSE FORM

PLEASE PRINT, FILL IN AS APPROPRIATE, AND MAIL TO:

Dr. Jay Joshi, President AIA
13608 Maidstone Lane
Potomac, MD 20854

[__] Enclosed is my check or money order for $________

[__] I am unable to attend but enclosed is a donation for $ ________

[__] I am remitting the Academic Award Graduate Registration form along with $10.00 registration fee for each awardee.

[__] I would like to sponsor the following award in the amount of $ ________

NAME OF THE AWARD: ____________________________________

[__] I would like to include the following congratulatory message or other material in the brochure (Camera ready copy on a separate page will be appreciated).

Donation to sponsor an award by an individual is $50 for scholastic achievement, $65 for excellent scholastic achievement and $80 for outstanding scholastic achievement.

The congratulatory message and advertisement rates for the program brochure are:
1/4 page $50,1/2 page $80, full page $150, inside cover page $200, and outside (back) cover page $250. - A camera ready copy will be helpful.

(PLEASE MAKE CHECKS PAYABLE TO AIA - All contributions to AIA are tax deductible as permitted by the law.)

Name:_____________________________ Signature ____________________

Date___________

Thank you for your kind cooperation.