Please print and complete the form below and return with your gift to:
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| Payment Method: If you would like to make your gift using your credit card, please complete this section. *Card type: (check one) |
| VISA Mastercard AMEX |
*Credit card number: |
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*Name as it appears on credit card: |
*Expiration Date: |
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*Enter Numeric Address |
*Billing Zip Code: |
| Individual Information: |
EMP# /STUDENT ID/ SSN: |
| *Title: |
*First name: |
Middle initial: |
*Last name: |
| *Apt./Suite: | *Street: |
| *City: | *State: | *Zip: | *Country: |
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*Home phone: |
E-mail address: |
| USF affiliation: | alumnus/a | friend | parent | faculty/staff | current student |
| If USF alumnus/a, please indicate: |
Graduation year: |
Name at time of graduation: |
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Campus: |
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| Is your spouse an USF graduate? | Yes | No |
If yes, please give the campus: |
| (required if yes) |
Spouse |
Spouse graduation |
Spouse |
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Campus: |
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*Gift Amount: |
$1,000 |
$500 |
$250 |
$100 |
$50 |
Other:__________________ |
| *Gift Designation: | Annual Fund | Undergraduate Scholarship | Graduate Scholarship | |||||
| Crosley Expansion | Faculty Support | |||||||
| Other:_______________________________________________________________________ | ||||||||
| Help us keep your employment information current: | |||||||||||||||
| Job title: | |||||||||||||||
| Employer: | |||||||||||||||
| Street address: | |||||||||||||||
| City: | State: | Zip: | Country: | ||||||||||||
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