Fillable e sidents ce GOLD PRESIDENTS CIRCLE-$5,000 BLUE PRESIDENTS (Angelo State University)

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e sidents ce GOLD PRESIDENTS CIRCLE-$5,000 BLUE PRESIDENTS (Angelo State University)

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¨ GOLD PRESIDENT’S CIRCLE-$5,000
¨ BLUE PRESIDENT’S CIRCLE-$2,500
¨ PRESIDENT’S CIRCLE -$1,000
¨ PLATINUM PRESIDENT’S CIRCLE-$1,500
MEMBERSHIP LEVELS
e sident’s ce
this represents my:
¨ quarterly payment ¨ semi-annual payment
¨ annual payment
name: _____________________________________________________
spouse: ____________________________________________________
my check is enclosed. (please make payble to asu foundation)
bank withdrawal (my voided check is included)
charge $________ to: ¨visa ¨mc ¨amex ¨disc
card number:_______________________________________________
name on card:______________________________________________
exp:___/___/___ date:___________________
signature:__________________________________________________
address:___________________________________________________
city/state/zip:______________________________________________
phone:_____________________________________________________
email: _____________________________________________________
¨recognize me in printed materials as:
__________________________________________________________
¨i wish to remain anonymous
¨please contact me regarding my membership options
¨i wish to decline all membership benefits
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e sidents ce GOLD PRESIDENTS CIRCLE-$5,000 BLUE PRESIDENTS (Angelo State University)

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Completed 17 August 2020

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