EFTA00309600

Payment Name(s) (as you wish to be listed in all printed materials) Address City/State/Zip Phone Email O Enclosed is a check for $ O Please charge $ to my: 0 MasterCard 0 Visa Card # Exp. Date: Signature O I/We are unable to attend. Enclosed is a contribution of $ Please make your check payable to The Washington Institute, and mail to 1828 L Street NW Suite 1050, Washington, DC 20036, or register online at hnpihruww.washingtonirastitute.org/StatesmanRSVP. The Washington Institute is a 501(cX3)ontanimtion. Your contribution, less $250 per person attending, is tax deductible by law (See htm://washin.st/ SSADInal). For more information, please contact Jacqui Schein at EFTA00309600