Israel Venture Network Membership Registration and Renewal Form

All contributions to Israel Venture Network are eligible for a full tax deduction in the United States. IVN’s tax ID number is 14-1891915. IVN accepts gifts of cash, publicly traded securities, restricted stock (with necessary approvals and marketability) and other marketable assets.

Israel Venture Network is a 501(c) (3) nonprofit organization. Your investment towards IVN is tax-deductible.

Please complete the information below so we can act in accordance with your wishes.

Registration Type (required)
 New Member Renewal

We are pleased to make / renew a commitment for the year 2012 to IVN to support its work in Israel with a gift of: (required)

Investment Method (required)

 Check Enclosed — Please mail to our offices: Israel Venture Network, 540 Cowper St., Suite 200, Palo Alto, CA 94301

 I plan to transfer money directly to IVN's US Account at: Silicon Valley Bank, Account# 3300412495, Routing# 121140399

 I plan to transfer stock to IVN’s Ameritrade account 781-329-768, DTC: 0188

 Please Charge my Gift to: MasterCard Visa American Express

Card Number (required)

Please charge my card:
 Annually Quarterly Monthly

Expiration Date (required)

I authorize Israel Venture Network (IVN) to charge my credit card for the specified amount and frequency

Please indicate how you would like your name to appear on IVN member lists:

Name (required)

Your Email (required)

Address (required)

City, State, Zip (required)

Office Phone (required)

Mobile Phone

Fax Number