INDIVIDUAL DONOR DONATION

2009 ISSHINRYU WORLD KARATE CHAMPIONSHIPS

Yes I (Name: _______________________________) would like to support 2009 World Championships hosted by The Pittsburgh Academy of Isshinryu Karate. I understand my contribution is tax deductible. Please make check payable to: IWKA-2009.

I would like to be acknowledged with the following:

____  Printed program.

____  IWKA web site (www.IWKA2009-pittsburgh.com).

I would like my donation to be listed as (check which _X_):

____  In honor of _________________________________________________.

_____In recognition of _____________________________________________.

_____In memory of _______________________________________________.

_____Anonymous.

_____Other______________________________________________________.

$_________Amount

                                                                                                                                     a/ab

                                                                                                 Individual Donor (b)

Donor Name (please print) ______________________________________________

       Signature > ______________________________________________________

Address (street, city,zip)  _________________________________________________________________________

_________________________________________________________________________

Phone (area code)___________________________________________________________

E-mail ______________________________________________________________

Receipt provided: _____Yes  ____No

Solicitor (name):____________________________________________________________

Date: ____________________________________________________________________

Check attached: _____Yes   ______ No ______ Check # ___________________________

IWKA 2009