DEPARTMENT OF GEOSCIENCES NORTH DAKOTA STATE UNIVERSITY DONATION FORM

Name(s): _________________________________________________________
Address: _________________________________________________________
_________________________________________________________________
_________________________________________________________________

My/our gift of $ _________________________ is pledged and presented to the North Dakota State University Development Foundation.

This gift is designated for the (check one):
[  ] Geo-Alumni Endowment (Fund #40092)
[  ] Geoscience Fund (Fund #33238)
[  ] Mayflower Endowment (Fund #25762)

• Cash: Enclosed is a check to the "NDSU Development Foundation"
  for $ ___________________.

• Credit Card: Please charge my gift of $ ___________________ to my
  [   ] VISA      [   ] DISCOVER      [   ] MASTER CARD      [   ] AMERICAN EXPRESS      [   ] DINER'S CLUB
  Account #: _______________________________________________
  Expiration date: ___________________________________________
  Card security code: ________________________________________
  Your signature: ____________________________________________

  Matching Gift: Enclosed is a matching gift from my employer or my spouse's company.