CONTRIBUTION FORM FOR KHALIFAH INSTITUTE FUND-RAISING DINNER

APRIL 9, 2005 SHERATON SUBANG HOTEL.

A DINNER TABLE FOR 10 PAX

Type Rate [RM] No. of Tables Amount [RM]

A 10,000.00 _____________ ______________

B 7,000.00 _____________ ______________

C 5,000.00 _____________ ______________

D 3,000.00 _____________ ______________

E 1,000.00 _____________ ______________

Total

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B In addition/alternatively, we would like to:-

Sponsor a table ____ for RM ________ for Non-Muslim diners/Converts

Make a cash donation amounting to RM _________

Take advertisement space in the Souvenir Programme as follows:-

Rate [RM]

Full Page Colour [Back Cover] 2,000.00

Full Page Colour [Inside Front Cover] 1,500.00

Full Page Colour [Inside Back Cover] 1,250.00

Full Page Colour 750.00

Full Page Black & White 500.00

Half Page Black & White 350.00

Quarter Page Black & White 200.00

If you wish to take up advertisement space, please provide us with your A4 size artwork and positive film by Mar 17, 2005.

C Sponsor’s particulars and details of payment are as follows:

Name of company/organisation: _____________________________________________________

Address: _____________________________________________________________________________

Tel No: __________________ Fax No: _________________ Email: ____________________________

Contact Person: ______________________________ Designation: ___________________________

Cheque No: _________________ Bank: ______________________ Amount RM ________________

All cheques should be crossed and made payable to “Khalifah Institute”.

If you need tax exemption for payment of RM 2,000.00 or more, please let us know.

Enquiries: Sarah: 03-4256 6810, Dr Alini Marzuki: 019-226 8411,

Nor Aishah Osman: 012-223 1961