The Fund for Empire State College Form for Mail or Fax Contributions (AF14WS)
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
**************************************************************************************************************************
Learners Society $250
Mentor Society $100
Anniversary Society $43
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 ______