EFSC Foundation Donor Opportunities Booklet | Page 7

AFFILIATION (Please select one ):
r Friend
r Employee
r Grad Year: _____________
r Other
Eastern Florida State College Foundation, Inc.
3865 North Wickham Road, FL 32935
Phone: [phone]
Fax: [phone]
Donation Amount: $ ______________________________
r Mr.
r Mrs.
r Ms.
r Dr.
r Other
Name: _________________________________________ Spouse: __________________________________________
Home Address: _____________________________________________________________________________________
City: _______________________________________________ ST: ________________Zip Code: __________________
Home Phone: _________________________________ Cell Phone: __________________________________________
Birthday (month/day): ______
Spouse DOB: _________ E-mail Address: ____________________________________
How would you like to be acknowledged in print materials? _________________________________________________
DONATION TYPE (Please choose one below)
r Unrestricted Foundation Donation r EFSC Textbook Scholarship Donation
r General EFSC Scholarship Donation r Other
METHOD OF PAYMENT
r Check/money order enclosed payable to EFSC Foundation
r Credit Card: ___ Visa ___ MasterCard
r ACH/Debit:
Name as it appears o