G I F T/ P L E D G E F O R M
T
hank you for your support of the UAB School of Health Professions. Please complete and return this form to make a contribution to the building fund-raising project.
Gifts and pledge payments may be made by check (payable to UAB), credit card, or by donation of appreciated stock. If you wish to make a donation of stock, please contact Daphne Powell, Director of Stewardship, at (205) 934-1807 or daphnep@uab. edu to receive further information and instructions. All donations are tax-deductible to the full extent allowed by law.
Please choose one of the following three options:
❑ My gift of: $_____________ is enclosed. OR
❑ I pledge: $__________________. My initial gift of $___________________ is enclosed. I would like to pay the balance of $_______________________ over: ❑ 1 year ❑ 2 years ❑ 3 years ❑ 4 years ❑ 5 years. Please send me a pledge reminder each year during the month of: _____________________ beginning in ___________ (year). OR
❑ I pledge: $__________________to be paid over: ❑ 1 year ❑ 2 years ❑ 3 years ❑ 4 years ❑ 5 years. Please send me a pledge reminder each year during the month of: _____________________ beginning in ___________ (year).
Please complete the following information:
Please record this gift/pledge as: ❑ Joint ❑ Individual ❑ Other _________________________________________________ Name(s) _________________________________________ Address _________________________________________ City ___________________ State ______ Zip __________
For contributions by credit card
Daytime phone number _____________________________
❑ MC ❑ Visa ❑ Discover ❑ American Express
Email ___________________________________________ ❑ I am interested in making a gift of appreciated stock, please contact me at _____________________________________ (phone or email address).
Card Number _______________________________________ Exp. Date _________________ Amount $________________ Name on card _______________________________________
❑ I am a UAB employee and am interested in making my gift through payroll deduction. Please contact me at ____________________ (phone or email) to discuss the payment schedule.
Please complete and return to: Katie Adams, UAB School of Health Professions, Webb Bldg. 624C, 1530 Third Avenue South, Birmingham, AL 35294-3361