Giving

Date:   mm/dd/yy Alumni: Yes No Graduation Year: *Last Name: *First Name: Maiden Name (if alumna): Spouse Full Name: Spouse Graduation Year: Honor Roll of Donors: Please enter your name as you would like it to appear on the Honor Roll of Donors listing. *Address: Address Line 2: Address Line 3: *City: *State: Select a state Not Applicable Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Oklahoma Ohio Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Yukon *Zip: Country: *E-mail: *Day Phone: Evening Phone: Pay by Credit Card Please check this box if you wish to pay by credit card. For privacy purposes, an employee from the office of institutional advancement will call you to obtain the credit card information. Please be sure to provide a telephone number indicating where we can reach you. Gift Amount: Pledge Check if you are paying on a pledge. Joint Gift Check if you are giving a joint gift with a spouse. If giving a joint gift with someone other than a spouse, indicate in the comments section below. Annual Gifts: Please enroll me in the Newton Society ($1-$499 annual unrestricted gift).     Please enroll me in the Kiah Circle ($500-$999 annual unrestricted gift).     Please enroll me in the President’s Circle ($1000-$4999 annual unrestricted gift).     Please enroll me in the Poetter Society ($5000-$9999 annual unrestricted gift.     Please enroll me in the Pepe Society ($10000-24999 annual unrestricted gift).     Comments: Use the space above for comments or questions that you may have. Thank you! Match: Yes No I will arrange to have my gift matched by my company. Company Name: Company City: Company State: Select a state Not Applicable Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Oklahoma Ohio Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Yukon Job Title: Company: Address: Address Line 2: City: State: Select a state Not Applicable Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Oklahoma Ohio Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Yukon Zip: Country: Phone: