Donor Name:

Co-Donor Name:

Affiliation:
Alumni – please indicate class year:
Parent
Faculty/Staff
Friend

E-mail:

Phone:

Please designate my gift to Supporting Science:
LEED level 1: $450
LEED level 2: $1,500
Element Paver: $5,000

Please recognize this gift on the wall and/or paver as indicated:**
(Examples: Robin Johnson ’85 and John ’84 Smith, Mr. & Mrs. Joseph Smith P’98, The Smith Family, etc.)

I would like to schedule my payments on my credit card.

I would like to receive reminders via US mail

I will fulfill this commitment on the following schedule: One-Time Monthly Quarterly Annual Amount per payment: Please send my first reminder on: 1 2 3 4 5 6 7 8 9 10 11 12 / 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 2008 2009

Checking this box indicates my signature and approval of this commitment.

* To confirm your purchase, a first installment must be paid by June 30, 2009. The maximum pledge period for the Supporting Sciences project is 3 years.
** For recognition names, please include donor name(s), class years or family names only. For the donor wall at LEED levels 1 & 2, Honorary or Memoriam gifts will also be recognized (i.e. “In Honor of …”).
*** Elements are awarded on a first-come, first-served basis. Therefore, we cannot guarantee availability.