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NIAAA
Endowment Contribution
Name _______________________________________________________________
(Please PRINT your name as you would like
it to appear on the Honor Roll of Donors)
Address _____________________________________________________________
City ____________________________ State
_____________ Zip Code _________
Home Phone _______________________ Business
Phone _____________________
Fax _________________________ E-mail
_________________________________
Endowment
Gift Opportunities:
Individual---------------------------------------------------------------
Corporate
$500____________________ Platinum _____________________
$10,000
$ 250 ____________________ Gold ________________________
$5,000
$ 100 ____________________ Silver _______________________
$1,000
$ 50 _____________________ Bronze ______________________
$500
$______________________ Contributor ____________________
$ ______
(Please
select a category above for your gift)
or
Consider $1.00 per year as an Athletic
Administrator for a Total Pledge of $ ________
or
Bequeath my NIAAA member Term Life insurance
in the amount of $ ____________ to the NIAAA Endowment
This gift is given in memory of ____________________________________
____________________________________________________________________________
Check Number _______
Credit Card Type _______ (MC or Visa only) # ____________________________
Signature _____________________________ Expiration Date
________________
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