Silliman University Alumni Association - New York/New Jersey Chapter

THIS FORM IS DESIGNED FOR DONORS RESIDING IN NORTH AMERICA I am pleased to contribute to the United Board for the Twin Portals Project for Silliman University.

The United Board welcomes contributions by credit card or check, as well as contributions of appreciated stock or securities. Gifts to the United Board for this project are tax deductible in the U.S. to the full extent permitted by law. If you are contributing by �� please be sure to make it payable to the United Board and enclose it with this form. To make a �� contribution (Visa orMasterCard only, please), please complete the credit card section below. You may also make a secure credit card gift on the web at . Gifts of �� may provide additional tax benefits. Please contact Shanna Hamilton (email:shamilton@unitedboard.org or phone: 212-870-2612) for the procedures to transfer appreciated securities to the United Board for this project.

Check: I am enclosing my check, �� , for $___________________. Credit card: Please charge my gift of US $_____________ to my MasterCard

Account Number: __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __ Expires __ __/__ __

Signature: ________________________________________________ Date: _______________ ��

Name: _________________________________________ Maiden name: __________________ (as it appears on credit card, if you are making a credit card gift)

(if applicable)

Address: ______________________________________________________________________ Phone: _____________________________(day) ______________________________(evening) E-mail: ________________________________ Yr. of Grad.: __________ Major:____________ Name of Silliman alumni chapter:

_______________________________________________________ I am are not currently affiliated with a chapter, but I would like to join one. I request that I be contacted with information about the chapter nearest me.

______________________________________________________________________________ The first 700 contributions of $1,000 or more will be permanently recognized with a metal leaf on the building’s “Tree of Life,” on which the donor’s name and/or the name(s) of any honoree or memorialee will be engraved.

�� United Board for Christian Higher Education in Asia Attn.: Shanna Hamilton

475 Riverside Drive, Suite 1221 New York, NY 10115

�� Mr. Jose Mari Antonio

Director of Institutional Advancement Silliman University

Dumaguete, Philippines

Unless donors request anonymity, it is the United Board’s normal policy to list donor names in the appropriate giving category of its annual report and to share donor and contribution informationwith Silliman University. As this started as a SUACONA project and continues to be promoted by them, the United Board may also share donor names and contribution amounts for this project with the officers of SUACONA, unless you request anonymity by signing the statement below. Signing this statement means that your name and the amount of your contribution will not be published by the United Board, SUACONA or Silliman,

� ��

��

Visa

�� , due to the significant bank processing fees charged for checks from outside the U.S. Such a credit card contribution is similar to a credit card purchase from a U.S. vendor, so your contribution will be in U.S. dollars, as shown above.

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