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Event Planning
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Scholarship Award Program Donation


Award A Scholarship in Your Company's Name
First Name:
Last Name:
Address:
City:
State: (ignore for non-US transactions)
Zip Code:
Country:
Email Address:
Confirm Email Address:
Preferred Phone:
Title (optional):
Organization (optional):
Credit Card Billing Address
 
 If the address where you receive the credit card bill is different than above, please enter it here.
Address:
City:
State:
Zip Code:
 

Company Name You Want on The Scholarship?
Contact Name?
Company Representative the Night of the Banquet?
Please Give In One of The Following Categories
Charge Amount:
$1,000.00 -
$1,500.00 -
$2,000.00 -
$2,500.00 -
$3,000.00 -
$4,000.00 -
$5,000.00 -
  Other Amount --> $
  You can choose any amount you'd like by checking the box for the amount you'd like to give, or by checking the Other option and entering a custom amount in the blank field.
Pay by Credit Card  
Card Type:
Credit Card Number:
Credit Card Expiration (mm/yy): /
Name On Card:
C V V Value: