DONOR RESPONSE SHEET

Print & return SIGNED form along with payment method to:

JEMS/AACF

948 E Second St

Los Angeles, CA 90012

(213) 613-0022

NAME: /
ADDRESS:
CITY: / STATE: / ZIP:
PHONE: / () / EMAIL:

Amount as my preference being given to the following account(s):

Check box & enter amount : General Scholarship

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DONOR RESPONSE SHEET

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DONOR RESPONSE SHEET

$ AACF General

$ AACF - LTC

$ AACF – PNW Region

$ AACF – NorCal Region

$ AACF – SoCal Region

$ AACF – University of Washington

$ AACF – UC Davis

$ AACF – UC Berkeley

$ AACF – San Francisco State University

$ AACF – San Jose State University

$ AACF – UC Santa Cruz

$ AACF – Cal Poly San Luis Obispo

$ AACF – UC Los Angeles

$ AACF – UC Santa Barbara

$ AACF – University of Southern California

$ AACF – UC Irvine

$ AACF – Cal State Long Beach

$ AACF – UC Riverside

$ AACF – UC San Diego

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DONOR RESPONSE SHEET

Amount as my preference being given to the following campus minister account(s):

(For payment by check, ONLY list number below on memo line)

$ 37020Chong Ahn, University of Washington (UW)

$ 34420Melanie Mar Chow, Leadership Team/USC

$ 34470David Fong, Cal Berkeley

$ 37010Jonathan Liu, Leadership Team

$ 34560Arnie Ong, SF State

$ 37000Victor Quon, Leadership Team/Leadership Trng & Development

$ 11420Carolyn Shimabukuro, JEMS PNW Coordinator/AACF UW

Please indicate payment method:

Check (Please make payable to JEMS/AACF)

EFT monthly gift (See below for Electronic Bank Withdrawal authorization)

EFT AUTHORIZATION FORM

I, (print name) agree to contribute monthly to JEMS/AACF to the accounts designated above through the Electronic Fund Transfer (EFT) program. I authorize my bank to pay JEMS/AACF the amount(s)indicated above on the 1st or 15th work day of every month. This authorization will remain in effect until I notify in writing to JEMS/AACF that I wish to change/finish contributions.

Staring the month of: on the 1st or 15th day (check choice)

SIGNED: ______DATE: ______

Enclosed is my VOIDED BLANK CHECK from the bank account to be used for EFT withdrawal.

Thank you for supporting AACF!

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