Please print, complete, and return this form to the address indicated therein.

The Edinboro University Athletic Department thanks you for your financial support!

Name	Business
Mailing Address
City	State	Zip
Phone (res.)	Phone (bus.)
E-mail Address
Amount of Contribution
Balance to be Paid: Annually ___ Semi-Annually ___ Quarterly ___
Please charge to my: Visa ___ MasterCard ___	Card #
Signature as on credit card:	Exp. Date
Make donation payable to: Edinboro University Foundation
___ General Athletic Fund ___ Sport Specific or Endowment (list):
If applicable, please list shirt sizes (S, M, L, XL, XXL): t-shirt ___ sweatshirt ___ polo ___
Please mail to: Bruce R. Baumgartner, Director of Athletics 219 Meadville Street Edinboro University of Pennsylvania Edinboro, PA 16444 For more information, please call Sue Goldthwaite at (814) 732-2776 ext. 224.
AMOUNT OF CONTRIBUTION Membership Levels Please check the appropriate level: ___ Varsity Club: $50-$99 ___ Scots' Club: $100-$249 ___ Captains' Club: $250-$499 ___ Coaches' Club: $500-$999 ___ Athletic Director's Club: $1,000-$2,499 ___ President's Club: $2,500-up ___ Check to waive all donor benefits in order to maximize your IRS deduction. ___ Please make my donation anonymous, not to be included in any listing.