An Online Math Education Community Center

Please complete all sections of this form and forward to:

The Math Forum
ATTN: Gift Processing
3141 Chestnut Street, 1-310
Philadelphia, PA 19104

Full Name:  ____________________________________________
Street Address:  ____________________________________________
City: ____________________________ State: ____  ZIP: _________
Phone:  ________________________________
E-mail:  ________________________________

Please select the amount of your gift: 
__ $10 
__ $25
__ $50
__ $100
__ $250
__ $500
__ $1,000
__ $2,500
__ $5,000
__ Other : ______________

Special Instructions: ________________________________________________________________
 
 
 
__ Enclosed is my check or money order payable to "The Math Forum/Drexel University"

__ Please charge $________ [complete amount from above]
to my AMEX/DISCOVER/MC/VISA [please circle]
Account number:  __________________________________
Expiration (mm/yyyy): ___ / ____
Authorized Signature  ________________________________________________

Your signature above authorizes The Math Forum/Drexel University
to charge your account the amount indicated above.
Thank you for your support!
 			
Matching Gifts:

Many companies match employee and retiree contributions to educational organizations, which may make your 
contribution go 2, 3, or 4 times as far! 
See if your/your spouse's company has a matching gift program.

If you do qualify, please complete the information below, obtain a matching gift form,
and enclose it with your gift.

*  Please fill out this section if you work for a company with a corporate matching gift program (see above). 


Your Title ___________________________________________
Your Employer ___________________________________________
Address  ____________________________________________
City ____________________________ State ____  ZIP _________

__ If retired, please check here. 

Please complete the following questions to help us improve The Math Forum:

Please indicate any aspects of the Math Forum that you find particularly useful or worthy of support: 
__ Ask Dr. Math
__ Problems of the Week
__ Teacher2Teacher
__ Internet Mathematics Library
__ Discussion Groups
__ Teacher Exchange
__ Other: ___________________________________________

Your role: 
__ Student  
__ Teacher 
__ Instructor/Professor  
__ Parent/Guardian 
__ Administrator  
__ Mathematician  
__ Researcher  
__ Consultant  
__ Policymaker 
__ Sponsor/Foundation 
__ Staff  
__ Other: ___________________________________________

Level of the resources in which you are interested (if appropriate): 
__ All  
__ Elementary  
__ Middle  
__ Secondary  
__ College  
__ Graduate  
__ Adult Education

Other comments you would like to make: _________________________________________________________