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NAMING OPPORTUNITY The Thomas Jefferson Auditorium

To reserve your seats, send this form to auditoriumlaciteduvin@fondationccv.org before the end of July 2016.

Donor information: Last Name: _____________________________ Address: ____________________________________________________________________________________ City: _____________________ State: ____________________ Zip Code: _______________________ Email: _____________________________________________________ Telephone: ____________________ Contact details to send the certificate and the desk monument (if different from the one above): Last Name: _______________________________________ First Name: ________________________________ Address: ___________________________________________________________________________________ City: ______________________ State: _____________________ Zip Code: _______________________ Please note that given the limited number of seats, seats will be allocated on a first come first served basis. Procedure to follow: Send the application form “Sponsor a seat” to auditoriumlaciteduvin@fondationccv.org Seat will be confirmed by email, then proceed to the payment. If no payment received within 4 working days after the confirmation, the seat will be made available for sale to another party. Seat information: Complete the following table to reserve your seat(s).

SEAT CATEGORY PRICE NUMBER OF SEATS DESIRED FOR EACH CATEGORY TOTAL AMOUNT

Black (rows G-K) $5.500

Yellow (rows D-F) $4.500

Green (rows B-C) $3.500

Fisrt Name: ________________________________

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Naming of the seat(s): Please give the seat row of the seat you would like to reserve, its number (example: row B No. 7) and the name you would like to associate to the seat. Note that you can reserve as many seats as you want. If you want more than 8 seats, please use the following table as many time as you need.

Seat row Seat number Name to engrave on the seat

(34 characters max.)

Payment method: □ Cheque: payable to AFCCV

send to the attention of George Sape, Epstein Becker & Green PC, 250 Park Avenue, NYC 10177 □ Credit card: on line on the American Friends of La Cité du Vin website www.afccv.org For credit card transaction, please call Judy Levy at (212) 351-4943 or Jennifer Mills at (212) 351-3785 □ Bank transfer: information below American Friends of La Cité du Vin- Bank information: Direct to Wire Routing Transit Number (RTN/ABA) 121000248 The International SWIFT/BIC code is: WFBIUS6S (USD payments)

WFBIUS6WFFX (foreign currency payments) Bank name Wells Fargo Bank, N.A. Beneficiary Bank Account Number 5279249196 Beneficiary American Friends of the Center for Wine and Civilization, Inc. George Sape c/o Epstein Becker & Green 250 Park Avenue New York, NY 10177-0001CHIPS Participant 0407

You will receive a tax credit letter after the donation is received.

Thank you for your contribution.