MRC Gala 2006 Ticket Purchase Form

Thursday, March 30, 2006 | Grand Hyatt Washington

Price is $250 per person.

 YES, I/we will attend the 2006 Media Research Center Annual Gala featuring the DisHonors Awards and a Special Tribute to the American Military.

Number of Attendees:________

Name(s): _______________________________________________________

Guest Name(s):__________________________________________________

Guest Name(s):__________________________________________________

Address: _______________________________________________________

City: __________________________  State: _________  Zip: ____________

Country (if not U.S.A.): ____________________________________________

Telephone: _____________________________ (in case there is a question about your credit card)

Email: _________________________________________________________

  __ Visa __ American Express   __ MasterCard   __ Discover

Card Number: _________________________________________________

Expiration Date: ____________________

Name as it appears on card: ______________________________________

Total Amount:____________________

Please mail this form to:
Media Research Center
Attn: Melinda Brown
325 S. Patrick Street
Alexandria, VA 22314
Fax: 703-683-9736

* Please RSVP by Monday, March 13, 2006.
If you require additional information, please contact:
Melinda Brown
Phone: 703-683-9733, ext. 163,
Email: MBrown@mediaresearch.org		 To Make a Reservation with the Hotel:
- Group Room Rate: $239, ask for the Media Research Center Room Block
- Phone: 1-800-233-1234
- Cut-off date: Wednesday, March 7, 2006