NIAAA Endowment Contribution

Name _______________________________________________________________
(Please PRINT your name as you would like it to appear on the Honor Roll of Donors)

Address _____________________________________________________________

City ____________________________ State _____________ Zip Code _________

Home Phone _______________________ Business Phone _____________________

Fax _________________________ E-mail _________________________________

Endowment Gift Opportunities:

Individual--------------------------------------------------------------- Corporate

$500____________________ Platinum _____________________ $10,000

$ 250 ____________________ Gold ________________________ $5,000

$ 100 ____________________ Silver _______________________ $1,000

$ 50 _____________________ Bronze ______________________ $500

$______________________ Contributor ____________________ $ ______

(Please select a category above for your gift) or

Consider $1.00 per year as an Athletic Administrator for a Total Pledge of $ ________ or

Bequeath my NIAAA member Term Life insurance in the amount of $ ____________ to the NIAAA Endowment

This gift is given in memory of ____________________________________

Check Number _______
Credit Card Type _______ (MC or Visa only) # ____________________________
Signature _____________________________ Expiration Date ________________