Yes!  I would like to support the
Dr. Leo W. Parks Lectureship in Microbial Physiology.

Gift Intention Form

MY TOTAL GIFT AMOUNT WILL BE: $___________.

__ This is a corporate pledge/gift.  Company name:___________________________________________________________________________________

__ A check for the total amount of $_______ is enclosed.

__ I would like to charge my entire gift.
Card Type: __American Express  __Discover  __Mastercard  __Visa 
Card Number: _______________________________
Expiration Date: ____________________________
Name on Card: ______________________________
Signature: __________________________________

__ A check for $________ as my first payment is enclosed.  A balance of $________ remains on my pledge and will be paid in equal annual installments over the next ___ (1-5) years.

__ I have completed a Bank Draft/Payroll Deduction Form.  Each month for the next ___ (1-5) year(s) $_______ ($10 minimum) will be deducted.

(Print) Name____________________________________________________________________________
Phone____________________(Day) ___________________(Eve.)
FAX_____________________ Email__________________________ Website___________________________________________
Address___________________________________________________________________________________________________
Employer (many match gifts to NC State!) ________________________________________________________

Please make checks payable to The North Carolina Agricultural Foundation.
You will receive an official receipt for your contribution and reminders if you have made a pledge.
Send to: NC Agricultural Foundation, NCSU Box 7645, Raleigh, NC 27695.
  If you have any questions or require additional information, please call Gerry Luginbuhl at at 919-515-7484 or Chris Wessel at 919-515-7678.



 Return to:
 Foundations and Development Home
 CALS Home
 Department of Microbiology
 NC State Home



 Last modified:  May 2003
 cals_foundation@ncsu.edu