Donate Via Mail

UIC College of Pharmacy Donation Form

Donation FormName

Name if different as a student

Class Year and Degree

Spouse's Name

Spouse's Class Year and Degree

Join Gift? Yes No
Mailing Address

Place of Employment

My employer is a matching gift company.
Yes, paperwork is enclosed.
Yes, paperwork will follow.
No.
I don't know.

Please add me to the bimonthly e-mail newsletter for pharmacy alumni.
My e-mail address is

Gift
Mortar and Pestle Society $10,000.
The Dean's Circle $1,000.
The Sustaining Circle $500.
Take a Seat $250.00, list the donation in honor of
The Supporting Level $100
Other*

*With a $30.00 donation, you will receive one year subscription to UIC Alumni, a bimonthly magazine from the University of Illinois Alumni Association.

I understand that my gift will be applied to the area of greatest need through the Annual Fund.
I wish to direct my gift towards a specific fund:

Please send me more information about:

Alumni Volunteer opportunities
CE Programs
Advanced Degree Programs
Admissions Information to give to potential entry-level student
Planned Giving (Giving through wills, charitable trusts, pool income fund annuities and life estates.)
President's Council, a lifetime giving society
I wish to pay by credit card
VISA MasterCard American Express Discover
Number Exp. Date

Signature:

Your gift is tax-deductible as allowed by law. Please return this form with your gift.
THANK YOU!

Simply fill in the form, print it, and send it to us at:
Office of Advancement
UIC College of Pharmacy
833 South Wood Street (M/C 874)
Chicago, IL 60612
or FAX (312) 413-1910