University Of Memphis Faculty And Staff Giving Campaign Gift Form
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1Faculty and Staff Giving Campaign Gift Form
Dr./Ms.
Faculty
Mrs./Mr.
Staff
Name:
First
Middle
Last
Department / College / School / Program
Dr./Ms.
Mrs./Mr.
Spouse’s Name:
First
Middle
Last
Campus Address
Campus Phone Number
Home Address
q
I attended the University of Memphis from _____________ to _____________ .
City
State
ZIP
q
I graduated from the University of Memphis in __________________________ .
Please enter any previous name(s) if different from your current name:
Home Phone Number
Designating Your Gift
Enter the designation(s) for your gift and the portion of your total gift that each designation should receive. Individual gift amounts must add up to equal your total gift
amount. If you are making your gift using the payroll deduction, indicate the amount you authorize to be deducted per pay period. If you are not making your gift using
payroll deduction, indicate the total gift per designation you wish to make at this time.
I am giving a gift in
Please designate my gift to:
q
Honor of ______________________________________________________
1. ______________________________________
$ ________________.00
q
Memory of ____________________________________________________
2. ______________________________________
$ ________________.00
q
Please notify
q __________________________________
Academic Fund
$ ________________.00
Name
q __________________________________
University Libraries
$ ________________.00
Address
TOTAL
$ ________________.00
City
State
ZIP
q My spouse works for a company that will match our gift and a completed form is attached.
Making Your Gift
Payroll Deduction
q I authorize the University of Memphis to deduct $ _______.____ per month, effective with the next pay period and continuing
until I request otherwise.
q I authorize the University of Memphis to increase my gift amount to $ _______.____ per month, effective with the next pay period
and continuing until I request otherwise.
Signature: __________________________________________
Date: ____/____/____
Credit Card
q I authorize the University of Memphis to charge my credit card in the amount of $ _______.____
m MasterCard
m Visa
m Discover
m American Express
Card #: __________________________________________
Exp: ____/____/____
Signature: ________________________________________
Date: ____/____/____
Check
q I am enclosing a check, payable to the University of Memphis Foundation for $ _______.____
Thank you for your support! Your gift makes a tremendous impact at the University of Memphis!
Please return this form to 102 Alumni Center. If you have any questions, please call 678-3953.
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Parent category: Letters