We wish to purchase _____ tickets at $75/person                               $ ________

I/we wish to be a __________________________ sponsor                   $ ________

I/We will be unable to attend, but would like to make a donation  $ ________

Name:   _________________________________________________

Address:   ________________________________________________

City:   ________________________   State: ____  Zip:  _____________ 

Telephone:  ___________________   E-mail:  _____________________

Check, VISA, MasterCard and American Express accepted (circle one)

____________________________________     ______________________

Credit Card #                                                                          Expiration Date

Please return this card with payment or fax, make checks payable to:

The Desi Geestman Foundation

3131 Foothill Boulevard, Suite L  La Crescenta  CA  91214

818.249.1105  fax 818.249.1003  www.desigeestmanfoundation.org

Kindly respond by October 1, 2009

Please consult your tax advisor for tax benefits Tax ID 95-4728343