I ___________________________________________________________, hereby pledge $10,000 (Ten thousand dollars) to the Economic Club of New York on the occasion of the Centennial Anniversary of the Club.

Payment will be made by check payable to The Economic Club of New York, or

Credit Card: Visa _____ Mastercard _____ American Express _____

Card Number: _________________________________ Expiration Date: ________

or the transfer of securities, by ______________________________________ 2016.

Please contact the Club office for information regarding transferring securities. Contributions will be fully tax deductible to the extent provided by law.

The Economic Club’s Federal ID # is 13-1655225

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Signature Date

Name: _____________________________________________________________

Address: ___________________________________________________________

____________________________________________________________

____________________________________________________________

Phone: ________________________ E-Mail: ______________________________

Please return the completed form to:

The Centennial Society

The Economic Club of New York

350 Fifth Avenue, Suite 4910

New York, NY 10018

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