|
|
98887 |
|
||
|
|
Office of Development Box 1893 Providence, RI 02912 Phone: 800.662.2266 Fax: 401.863.3301 |
|
||
|
|
|
Date: ___/___/_______ |
|
|
| Section I: Donor Information |
|
|||
|
Name: |
____________________________ | Class/Parent year: ________ |
|
|
|
Spouse: |
____________________________ | Class/Parent year: ________ |
|
|
|
Address: |
____________________________ | Daytime Phone: _______________ |
|
|
| ____________________________ | Evening Phone: _______________ |
|
||
| ____________________________ |
|
|||
| Section II: Gift Allocation |
|
|||
| Annual Support |
|
|||
|
Brown Annual Fund |
$ ________________ |
|
||
|
Brown Medical School Annual Fund |
$ ________________ |
|
||
|
Brown Sports Foundation (All-Sports Fund) |
$ ________________ |
|
||
|
Other Sports ________________________ |
$ ________________ |
|
||
|
Brown Alumni Magazine |
$ ________________ |
|
||
|
Other ________________________ |
$ ________________ |
|
||
|
TOTAL |
$ ________________ |
|
||
| Capital Gifts |
|
|||
|
New Endowment (have a representative call me) |
|
|||
|
Add to Existing Endowment _____________ |
$ ________________ |
|
||
|
Facilities/Other _______________________ |
$ ________________ |
|
||
| Section III: Gift Opportunities |
|
|||
|
I would like to speak with a representative from the Office of Development regarding: |
|
|||
| Bequests |
|
|||
| Gifts of Appreciated Assets |
|
|||
| Charitable Trusts or Annuities |
|
|||
| Named Endowment Funds |
|
|||
| Named Gift Opportunities |
|
|||
| Gifts of Tangible Personal Property |
|
|||
| Is Brown in your will or other testamentary plans? |
|
|||
| Yes No Would consider |
|
|||
| Section IV: Gift Instructions |
|
|||
|
This gift is: |
In honor of On behalf of In memory of |
|
||
|
Name: |
___________________________ |
|
||
| Section V: Credit Card Information |
|
|||
| Name:____________________________________ | (As it appears on card.) |
|
||
|
Type: |
American Express Brown MasterCard Brown VISA MasterCard VISA |
|
|
|
| ___________________________________ | __________________ |
|
||
|
CARD NUMBER |
EXPIRATION DATE |
|
||
| ___________________________________ |
|
|||
|
SIGNATURE |
|
|
||
|
Mail to: |
Brown University Gift Cashier Box 1877 Providence, RI 02912 |
|
|
|
