Osher Lifelong Learning Institute

Osher Lifelong Learning Institute

University of Pittsburgh

Name(s): ______Joint Gift? If yes, spouseother name: ______

Home Address: ______

Daytime Phone: ______Email ______

I’m proud to make a gift/pledge of:

$2,000 $500 $100 $25

$1,000 $250 $50 Other (please fill in) $______

Please direct my gift to the Osher Lifelong Learning Institute at the University of Pittsburgh.

Amount of Pledge/Payment (FY15 - July 1, 2014-June 30, 2015)

Designated for the Osher Lifelong Learning Institute at the University of Pittsburgh

$2,000 $500 $100 $25

$1,000 $250 $50 Other (please fill in) $______

Payment Options (Please read carefully and check all that apply):

One time gift payable online at www.giveto.pitt.edu/osherI will pay online at www.giveto.pitt.edu/osher

One time gift payable by check enclosed (Make check payable to the University of Pittsburgh).

One time gift to be charged to my credit/debit card (provide credit card information below)

I will make a gift with a single payment:

r  Check is enclosed. Checks should be payable to University of Pittsburgh.

r  I will make this gift by the following date: ______.

Pledge with monthly reminders

I will make a gift with a multi-payment pledge. Pledge with credit/debit card monthly automatic installments: (provide credit card information below)

Monthly amount to be charged: ______Start Date: ______End Date: ______

Name on credit/debit card: ______

Choose one: VISA MC Discover Amer Exp

CARD NO: ______

Expiration date: / (MM/YY) Security code (3 or 4 digits) ______

Signature: ______

I would like to schedule my payments as follow:

______.

Bill my credit card below (minimum $10 - please select which option)

One time payment, full amount of donation (please fill out CC information)

Choose one: VISA MC Discover Amer Exp

CARD NO: ______

Expiration date: / (MM/YY) Security code (3 or 4 digits) ______

I will make monthly payments by credit card or debit card and will contact Daniel Parker, Institutional Advancement, University of Pittsburgh at 412-624-6278

Other (please list, includes Appreciated Securities):

______

Additional information

I wish my gift to be anonymous.

I would like to make my gift with Appreciated Securities or another method not listed. Please contact me.

My gift will be matched by: ______

I would like more information about Planned Giving.

Questions about Osher - Contact Jennifer Engel at or 412-624-7072

Questions about your donation - Contact University of Pittsburgh,

Office of Institutional Advancement, Park Plaza, or 412-624-5800

Signature(s): ______Date: ______

Thank you for supporting the Osher Institute!

Name:______Joint Gift? If yes, spouse name______

Home Address______

Daytime Phone Email

I’m proud to make a gift/pledge of:

$2,000 $500 $100 $25

$1,000 $250 $50 Other (please fill in) $______

Please direct my gift to the the Osher Lifelong Learning Institute at the University of Pittsburgh

Payment Options (please read carefully and check one)

One time gift payable by check enclosed (Make check payable to the University of Pittsburgh

One time gift payable online at www.giveto.pitt.edu/osher

One time gift to be charged to my credit/debit card (provide credit card information below)

Pledge with monthly reminders

Pledge with credit/debit card monthly automatic installments: (provide credit card information below)

Monthly amount to be charged Start date Stop date

Visa MC Discover Amex

Name on credit/debit card

Card Number Expiration date______

Signature______

Appreciated Securities

No. ______shares of______

No.______bonds of______

For more details please call 412-624-5800 or refer to http:www.giveto.pitt.edu/ways/gift_of_securities.asp.

Additional Information

___I wish my gift to be anonymous

___My gift will be matched by :______

__ I would like more information about Planned Giving

Questions about Osher - Contact Jennifer Engel at or 412-624-7072

Questions about your donation - Contact University of Pittsburgh,

Office of Institutional Advancement, Park Plaza, or 412-624-5800

Appeal Code: AOLLI