The Mihan Foundation's questionnaire

QUESTIONNAIRE / CONTRIBUTION FORM

Personal		Professional
First Name		Profession
Family Name		Company
Date of Birth		Title
Place of Birth		Education
Citizenship		Field
		Degree

Your address and contact information
Street		P.O.Box
Apt #		Home Phone
City		Work Phone
State		Fax
Zip Code		E-Mail
Country		Website
Contribution	$25 $50 $75 $100 $250 $500 $1,000 other
Additional Information/Notes or Comments (please re-type the amount of your contribution in the comment field) Feel free to add any additional information that you may wish to share with us.
I will mail a check in the amount of....

The information you provide will be strictly confidential and will NOT be shared with anyone.

If you are interested in becoming a member, we offer two categories: Regular Membership (US $120 per annum) and Student Membership (US $60 per annum).

U.S. Donors who contribute $250.00 or more, should keep the Mihan's receipt with their tax records as their charitable deductions could be disallowed if the receipt is not produced in response to an IRS request.

(Members who have already paid their dues are welcome to contribute additional funds, if they so desire.)
Please make your checks payable to The Mihan Foundation, Inc. (Please do not send cash).

The Mihan Foundation, Inc.
P. O. Box 1740
West Bethesda, Maryland 20827-1740

* The Mihan Foundation has been qualified by the United States Internal Revenue Service as a 501 © (3) organization. Accordingly, all or part of your contribution may be deductible by you as a charitable contribution under the applicable rules of the Internal Revenue Code, as amended.