Home Address: __________________________________________________
City, State, and Zip: __________________________________________________
Home Phone: ____________________________ Work Phone: __________________________
E-mail address: ________________________________________
Work Address: _______________________________________________
City, State, Zip: ________________________________________________________
To support the priorities of the Campaign, I (we) pledge the sum of $___________.
My (our) pledge will be payable in installments of $ __________ over the next ____ years (we encourage pledges paid over 5 years), beginning _____________, on the following schedule (check one): __ annually, __ semi-annually, __ quarterly, __ monthly
I (we) have enclosed a down payment of $ ________________
___ Gift of stock: _____________________ shares of _____________
___ My employer will match my gift.
Please list (my) our names in all Campaign Reports and on the Campaign Wall of Honor in the appropriate Giving Circle as follows:
__ I (We) wish to remain anonymous.
Signed: ________________________________ Date: __________________