ASM Education Foundation

ASM TWIN TIER CHALLENGE

CONFIRMATION OF GIFT INTENTION

_________

YES ! I / we will support the ASMTWIN TIER Challengeas follows:

$_________________________Annual investment contribution

(Indicate annual gift amount)

X

___________________Number of years this gift will be paid

(Indicate # of years)

$_______________________Total pledge

_________

Send me a pledge reminder:______quarterly______annually______monthly

_________

I understand that others may/will match this gift

_________

Permission is granted to publicize our gift as shown:

DONOR NAME (S)__________________________________________


DATE_________________________________________

Please print clearly and indicate exactly how you wish your name(s) to appear in publications

Address: ______________________________________________________________________________________