DONOR’S NAME:______________________________________________________
ADDRESS: _______________________________________________________
________________________________________________________
E-Mail: ________________________________________________________
Enclosed is my contribution:
( )$15 ( )$25 ( )$50 ( )$100 ( )$_____________
I wish to make a pledge of $1,000 as a:
(to be paid over a 10 year period)
Enclosed is my $100 pledge payment for:
( ) Golden Benefactor ( ) Double Golden Benefactor ( ) Sterling Benefactor ( ) ______________
I would like my contribution to be added to the endowment fund for
the following scholarship: ________________________________________________
(Unless otherwise specified, all contributions are used by the General Fund to support
general philanthropies and operational expenses.)
This gift is in honor of____________________________________________ *
This gift is in memory of _________________________________________ *
*Please notify the following person of this gift:
________________________________________
________________________________________
________________________________________
( ) Please send information about including the Foundation in my estate planning.
Sandra Wiese, Treasurer Mu Phi Epsilon Foundation 9099 Regency Woods Drive Kirtland, OH 44094-9380
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rev. 1/19/05
Send contribution to:
( ) Golden Benefactor (1st $1000)
( ) Double Golden Benefactor (2nd $1000)
( ) Sterling Benefactor (3rd $1000)
( ) $4,000 or higher
MU PHI EPSILON FOUNDATION CONTRIBUTIONS
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