Advertising Industry Emergency Fund

Ticket Order Form

Movie Night: Get Smart
June 26, 2008

Company Name

Name / Title

My Address

My City

My State

My Zip Code

Phone Number

Email Address

Please show your support by indicating the quantity of each:

	Quantity
Individual Ticket - $20
Total

Check here if you are an AIEF Member:

Guardian Member Benefactor Member AIEF Member

Payment information

Check enclosed
Please charge my credit card: Amex Visa Mastercard

Credit Card Number:

Expiration Date: /

Signature:

Comments/Questions (optional):

Please fax or email insertion orders to: 310-285-3279
Contact: Nicole Levitt at 310-397-7830 Email: nicole@aief.org
11700 National Blvd., Suite L230, Los angeles, CA 90064