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AOCS Foundation Donation Form

NOTE: If you do not want to donate online by credit card, please print this page and fax, or mail, it back to the address at the bottom of this form.

Date: (mm/dd/yy)

04/24/14

First Name

Last Name

Title (optional)

Company (optional)

Address

City

State/Province

Postal Code

Country

Business Phone (optional)

Fax Number (optional)

E-Mail

Are you an AOCS member?

yes no

AOCS Member Number

I would like to join the Foundation Century Club

Century Club $100

I would like to join the Corporate Century Club

$250 $500 $750 Other:

One-time amount of $

Pledge amount of $ per year for year(s)

Please apply my gift to:

*New!* Influencing Innovation Campaign

Campaign to Update Technology & Communication Products

Annual Fund (unrestricted)

I have included AOCS in my will.

I would like more information on Planned Giving Opportunities

Payment Information
I wish to pay by credit card.

Credit Card Number

Credit Card Security Number

Expiration Date

/

Name as Printed on Card

Signature: (retype name)

Signature must be the same as the name on the credit card:
For CAPTCHA purposes, please enter, as a number, the sum of thirteen and five.

To donate by mail, please print this form and, mail or fax this form to:
(make checks payable to: AOCS Foundation)

Ben Harrison
AOCS Foundation
P.O. Box 17190
Urbana, IL 61803-7190 USA
Phone: +1-217-693-4807
Fax: +1-217-693-4852

Donations to the AOCS Foundation are tax-deductible to the extent provided by law.

AOCS Foundation will respectfully keep your donation anonymous if that is your wish.

Thank you for your support!