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An Online Math Education Community Center Gifts by MailPlease complete all sections of this form and forward to:
The Math Forum 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. |

