Sponsorship/Membership Form
The Eurasia Center and its Eurasian Business Coalition

Section I: Personal Information

 

Principal Contact:________________________________________________
Firm/Organization:_______________________________________________
Address:_______________________________________________________
City/State/Zip Code: _____________________________________________
Tel/Fax/Email:__________________________________________________

Section II: Membership (Sustaining Sponsorship) Tax-Deductible


Type of Sustaining Sponsorship:  ___________________________________
Eurasian Business Coalition Board Membership and “Evening with the Embassy” Series

Type

Cost (USD)

     Place ‘X’ Here

Honorary Corporate Board Member EBC

$5,000.00

 

Platinum  

$3,000.00

 

Gold   

$1,000.00

 

Silver  

$500.00

 

 

Section II: World Russia-America Forum, May 2008 (Tax-Deductible)


Type of Sustaining Sponsorship:  ___________________________________
World Russian-American Forum Event

Type

Cost (USD)

     Place ‘X’ Here

President’s Circle

$25,000.00

 

Director’s Circle

$10,000.00

 

Platinum  

$5,000.00

 

Gold   

$3,000.00

 

Silver  

$1,000.00

 

 

Section III: Payment Information


Amount Contributed:______________________________________________
Paid by Credit Card (X):   ___VISA  ___MasterCard  ___Discover  ___AMEX
Card in Name of:________________________________________________________
Address of Card Holder (matches card): __________________________________
Expiration Date:______________ If paid by check please make check payable to:  The Eurasia Center

This form can be faxed to:  202-237-1452 or mailed to the:
The Eurasia Center and its Eurasian Business Coalition
4927 Massachusetts Avenue, NW
Washington, DC  20016  USA

To Contact the Eurasia Center or to arrange a meeting please email:
Dr. Gerard Janco, President, President@eurasiacenter.org or telephone:  202-494-0773  SPONSORSHIP is Tax-Deductible