Institute of 1770 is enclosed K Please bill my: o Amex o Visa o Mastercard Credit card number: Expiration date: Billing Zip Code: Name of Company (Corporate Cards): Date Signature K I want to be acknowledged as: in the gala program Please mail checks to: The Hasty Pudding Institute, 717 Fifth Avenue, 18

enclosed. (mailing address below) K Please bill my: o Amex o Visa o MasterCard Credit Card Number: Expiration Date: Billing Zip Code: Name of Company (Corporate Cards): Date Signature K I want to be acknowledged as in the gala program. Please mail checks to: The Hasty Pudding Institute, 717 Fifth Avenue, Mor F

enclosed. (mailing address below) K Please bill my: o Amex o Visa o MasterCard Credit Card Number: Expiration Date: Billing Zip Code: Name of Company (Corporate Cards): Date Signature K I want to be acknowledged as in the gala program. Please mail checks to: The Hasty Pudding Institute, 717 Fifth Avenue, Mor F