Campaign Pledge Form

Campaign Pledge Form

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The Braille Monitor – October 2000 Edition

Have you made your campaign pledge
yet? We need everyone's help. The construction cost of our projected National
Research and Training Institute for the Blind is eighteen million dollars. Please
take this opportunity to complete your pledge form. Without you our job will
be just that much harder.

The Campaign To Change What It Means To Be Blind Capital Campaign Pledge
Intention

Name:_______________________________________

Home Address:_______________________________

City, State, and Zip:_______________________

Home Phone: Work Phone:_____________________

E-mail address:_____________________________

Employer:___________________________________

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 five 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: __________________

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