Pledge And Acknowledgement Form - Arkansas Pi Beta Phi printable pdf download

Pledge and Acknowledgement form

Chapter Room Chairs, Angels of the Crest & Pavers

Donor Name(s): ________________________________________________________________________________

Address: ______________________________________________________________________________________

Phone: _______________________________________________________________________________________

Email: _______________________________________________________________________________________

Please provide your email address as this is how we will contact you to confirm the wording of your space, paver, etc.

Chapter Room Chair

_____ My gift of $2,000 should be recognized on a

as follows:

Name (Arkansas Alpha’s only): ____________________________________________________________________

Initiation Year: _____________________

_____ My gift of $1,000 should be recognized on the

Angels of the Crest

recognition outside the Chapter Room as follows:

Please note that any initiated member of Pi Beta Phi from any Chapter may be recognized as an Angel of the Crest. $1,000 per name;

members may be listed together.

Name _________________________________________________________ Initiation Year:_____________________

Courtyard Paver

_____ My

should be recognized as follows:

#______ of Small Pavers at $1,000 each for a total of $________________________

#______ of Large Pavers at $1,909 each for a total of $________________________

Small pavers consist of 3 lines of text with up to 20 characters on each line (including spaces)

Large pavers consist of 6 lines of text with up to 20 characters on each line (including spaces)

Line 1 _______________________________________________________________________________

Line 2 _______________________________________________________________________________

Line 3 _______________________________________________________________________________

Line 4 _______________________________________________________________________________

Line 5 _______________________________________________________________________________

Line 6 ______________________________________________________________________________

Pledge And Acknowledgement Form - Arkansas Pi Beta Phi