2 PAY TO THE °H0F R OF ENHANCED EDUCATION 6100 PED HOOK OTRS, SUITE B3 ST TEM.. 1348 Icahn School of Medicine at Mount Sinai RRSTBANK ST. THOMAS, VI 00802 101.7265'2216 Fifty Thousand and 00/100' 6/10,2014 $ '50.000.00 ••••••••••••••••••nmennteine* " ' Icahn School of Medicine at Mount Sinai Attn: Mount Sinai Development Office One Gustave L. Levy PI Box 1049 New York NY 10065 2581 • ENHANCED EDUCATION Icahn School of Medicine at Mount Sinai 5000 • Charitable contributions First Bank Operating ENHANCED EDUCATION 6/18/2014 Icahn School of Medicine at Mount Sinai 6/18/2014 5000 • Charitable contributions 50,000.00 50,000.00 2581 50,000.00 First Bank Operating 50,000.00 • 111111 III II IIIII III • EFTA00311293

i roe"?' DUBIN BREAST CENTER THIRD ANNUAL tigAd, FACT VS. FICTION LUNCHEON AND SYMPOSIUM TO REGISTER: FILL OUT AND RETURN THIS FORM WITH YOUR PAYMENT TO: THE MOUNT SINAI DEVELOPMENT OFFICE AT ONE GUSTAVE L. LEVY PLACE, BOX 1049, NEW YORK, NY, 10029-6574 OR VISIT PHILANTHROPY.MOUNTSINAI.ORG/DBCLUNCHEON TO REGISTER ONLINE. PLEASE RESERVE THE FOLLOWING: CI FACT TABLE AT $10,000 • Table for 10 at the luncheon with priority seating • Special recognition during the event • Recognition in the printed program • Listing on Dubin Breast Center AnnuaI Donor Wall • Membership of the Dubin Breast Center Circle of Friends Annual Giving Society anc will receive special benefits including important contact information card and invitations to attend members-only events O TRUTH TABLE AT $5,000 (LIMITED AVAILABILTY) • Table of 10 at the luncheon • Recognition in the printed program O KNOWLEDGE TICKET(S) AT $500 • Priority seating for one at the luncheon • Recognition In the printed program O EDUCATION TICKET(S) AT $300 (LIMITED AVAILABILTY) • Seating for one at the luncheon O I AM UNABLE TO ATTEND BUT WISH TO MAKE A FULLY TAX DEDUCTIBLE CONTRIBUTION OF $ O ENCLOSED IS MY CHECK Please make checks payable to 'Icahn School of Medicine at Mount Sinai' CI PLEASE CHARGE MY: 0 PERSONAL CREDIT CARD 0 CORPORATE CREDIT CARD CREDIT CARD NUMBER NAME ADDRESS PHONE 0 AMERICAN EXPRESS 0 VISA 0 MASTERCARD 0 DISCOVER EXP DATE COMPANY CITY STATE ZIP EMAIL Tax-IDI Contributions are tax-deductible to the extent provided by law. The non tax-deductible portion of each ticket is $85 and the non tax-deductible portion of each table is $850. Gifts from donor advised funds, foundations. and charitable trusts may not be used for purchases that provide tangible benefits to any individual. Tax receipts will be mailed after the conclusion of the event. Please contact us by telephone or email name removed from our distribution list of fundraising materials. f you wish to have your FOR FURTHER INFORMATION. P-EASE CONTACT REBECCA KANE SOL INSKY AT OR EFTA00311294