Empire State College

The Fund for Empire State College Form for Mail, Phone or Fax Contributions (AF12WS)

Name ______Graduation Year ______

Address ______Home Phone ______

City | State | Zip ______Email Address ______

Please apply my gift to: oGreatest Need oStudent Scholarships oAcademics oFaculty Excellence

5  My company / my spouse’s company will match my gift.

5  My company ______

5  Spouse’s company ______

5  None

I would like to make a gift:

5  In Honor of… Name ______

5  In Memory of… Name ______

5  Please provide address if you would like this person or their family notified:

______

5  I would like to make an anonymous gift.

Alumni, friends and employees are invited to join a donor society by contributing to one of the following levels:

President’s Club

Founders Society $5,000 +

Builders Society $2,500

Partners Society $1,000

Investors Society $500

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Learners Society $250

Mentor Society $100

Anniversary Society $41

Check is enclosed, made payable to Empire State College Foundation. Please charge $______to my credit card.

Visa MasterCard Discover AmEx Acct. Number______Expiration Date:______

Signature:______

Monthly payment option

I would like to make a recurring monthly gift of $______to be charged to my credit card on the 1st or 15th of every month starting

on______.

Mail form to: Give by Phone or Fax

Empire State College (800) 847-3000, ext. 2234

The Fund for Empire State College (518) 580-0700 Fax

28 Union Avenue

Saratoga Springs, NY 12866

If you want to make a gift of securities, or have any additional questions contact:
Diane Thompson, Director of Annual Giving email: phone: (800) 847-3000, ext.2337

We welcome hearing stories of why you feel it is important to give to Empire State College. ______

Would you allow us to use your story on our web site or publications with your name and graduation year?

Yes _____ No _____ Signature ______