Fashion Donation Form

Fashion Show Benefiting the

Jack & Mildred Sherman Residence

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Secure Connection - We collect all sensitive donor and credit card information using SSL (Secure Socket Layer) technology. This technology allows a donor’s web browser and the AABR web site (we use our hosting company secure web site host5.apollohosting.com) to exchange information using sophisticated encryption technology. For more information on SSL technology, please visit www.thawte.com.

This form allow you to register or make a general donation to this event by using your credit card.

Please be advised that if you wish to pay by check, you may do so by making them payable to:

AABR Foundation

P.O. Box 560247

College Point, NY 11356

(Please indicate in the memo portion of your check if you are making a general donation or purchasing tickets to the Fashion Show.)

I will attend the Dinner/Fashion Show

($40 per ticket...indicate your contact information & number of tickets below.

The tax-deductible portion of each ticket is $8.)

I cannot attend, but would like to make a donation

(Indicate your contact information and gift amount below. Your donation will be fully tax-deductible.)

1.Contact Information

First Name:

Middle Initial:

Last name:

Street Address:

Apt/Suite:

City:

State:

Zip Code:

Country:

Home Phone:

Alternate Phone:

FAX:

E-Mail:

2. Gift Amount

My total contribution:

$(U.S. Dollars)

3. Additional Information (if any)

3. Credit Card Information

(We accept Visa, MasterCard, American Express, and Discover.)

Credit Card Number:

Expiration Date:

-- mm/dd/yy

Name exactly as it appears on your credit card:

Please Review your information carefully and click the submit bottom. For further information or questions, please call (718) 321-3800.



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