We appreciate your interest in becoming a Nicholas Hobbs Society Member. Please print and mail the completed form to the following address:
|
The Nicholas Hobbs Society Vanderbilt Kennedy Center Gift Records VU Station B #357727 Nashville, Tennessee 37235-7727 |
Contact Information:
| Name: | _________________________________ |
| Address: | _______________________________________ |
| _______________________________________ | |
| _______________________________________ | |
| Phone: | _________________________________ |
| Email: | ___________________________________________ |
What type of donation do you wish to make?
(please check all that apply)
Nicholas Hobbs Society Member (involves a contribution of $1000 dollars or more)
Tribute Gift (choose type)
In Honor of Memory of ___________________________________________ (name of individual)
Name and address individual or family to whom we can send acknowledgement of your honor or memorial gift:
Name:___________________________________________
Street:____________________________ City:____________________________ State:____ ZIP:______________
Tribute Gift (choose type)
In Honor of Memory of ___________________________________________ (name of individual)
Name and address individual or family to whom we can send acknowledgement of your honor or memorial gift:
Name:___________________________________________
Street:____________________________ City:____________________________ State:____ ZIP:______________
Please select your contribution method(s):
Cash $__________________
Check $_________________
MasterCard Visa American Express Discover
| Card No: | ________ - ________ - ________ - ________ |
| Exp Date: | ______ / ______ |
| Amount: | $__________________ |
| Signature: | ___________________________ |
Vanderbilt Employee Payroll Deduction
| SSN: | ______________________ |
| Amount: | $__________________ (per pay period) |
| Duration: | __________________________________________ (i.e., until further notice, 1 year, 1 month, etc.) |
If your company matches charitable gifts, please mail appropriate forms to the aforementioned address.