Yes! I/We would like to support the Medical Industry Leadership Institute (MILI) this year! Name ___________________________________________________________ Address _________________________________________________________ City __________________________ State _________ Zip _________________ Preferred phone (_____) _______________ Preferred email __________________ I / we wish to give the following to the Medical Industry Leadership Institute ___$1000 ___$500 ___$250 ___$100 Other $________ Please direct this gift to the Medical Industry Leadership Institute: ___ Program Support (5295) ___ Research Support Fund (3609)
Payment Options
1. Check Please make your check or money order payable to the University of Minnesota Foundation.
2. Credit Card ___Visa ___MasterCard ___AMEX ___Discover
___________________________________________ _____________________ Credit card number Expiration date
_________________________________________ ___________________________________ Name as it appears on credit card Signature
3. Pre-authorized Payments (Electronic Funds Transfer) Donation amount (check one): $___________ Monthly ( ___1st or ___ 15th; start month _______________) OR $___________ Quarterly (The 1st of the month beginning _______________) Please allow 15-30 days for processing before pre-authorized payments begin. Please continue my donations ___ until my pledge of $_______ is satisfied. ___ indefinitely, until I contact you. Name(s) on account (please print) ______________________________________________ I authorize the University of Minnesota Foundation to process debit entries from my account. This authority will remain in effect until I give reasonable written notification to terminate this authorization or until the last specified payment date. I understand that the processing time to start or stop payments can take up to 30 days. ___ I have attached a voided check or savings deposit slip. (Or) ___ Use my credit card information provided above for my pre-authorized payments. Authorized signature _______________________________ Date ___________
Matching Gifts
___ YES! My company will match my gift. If you're not sure if your company matches gifts to the U, visit www.matchinggifts.com/umn or consult your company's human resources department.
Please mail to:	University of Minnesota Foundation C-M-9407 P.O. Box 70870 St. Paul, MN 55170-9407