SPECIAL EVENT REGISTRATION
2013 Spring Scholarship Luncheon: Daring to Soar
Houston Country Club, One Potomac Drive, Houston TX 77057
11:30 a.m. - 1:30 p.m.
Registration Deadline: Friday, May 3, 2013
Thank you for your generous participation in the GCSW Spring Scholarship Luncheon: Daring to Soar with Guest speaker Brené Brown
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If you wish to pay by credit card or electronic check, please fill out the form below and proceed to the next page for payment processing.
If you wish to mail in your payment, please print this page out and send the completed form along with check to:
University of Houston
Donor and Alumni Records
P.O. Box 867
Houston, TX 77001-0867
For any questions about the luncheon or registration, please contact Connie Loyd at clloyd2@uh.edu. Or call 713-743-3599
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YES! I/we support GCSW SCHOLARSHIPS through SPONSORSHIP of this inaugural fundraising event!
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| Table Purchase |
QTY |
Amount
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Individual Tickets $150 each
(Fair Market value = $50 per ticket)
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$
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$25,000 Dare to Shape the Future
(Fair Market value = $500 per table)
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$
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$15,000 Dare to Inspire
(Fair Market value = $500 per table)
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$
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$10,000 Dare to Provide
(Fair Market value = $500 per table)
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$
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$5,000 Dare to Motivate
(Fair Market value = $500 per table)
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$
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$2500 Dare to Care
(Fair Market value = $500 per table)
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$
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$1500 Dare to Encourage
(Fair Market value = $500 per table)
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$
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Total Registration:
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$
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Scroll down to enter your personal information
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Give Online Now
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Thank you for supporting the University of Houston. We truly appreciate your generosity and commitment to our
success. To make a one-time gift online using your credit card or bank account, please complete the following information
and click "Confirm your gift" button at the bottom of the page.
To set up a Recurring Credit Card Gift or Electronic Debit Gift, download and complete the
appropriate form and mail to the address at the bottom of the form.
Note: For persons wishing to make an online credit card donation from outside the United States, please
contact UH's Donor and Alumni Records at 877-755-0559. Please be prepared to have your credit
card number, expiration date and the 3 or 4 digit security code, along with your contact number
should we need to contact you. Thank you.
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Gift Information
Note: * indicates required fields.
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* I would like to make:
a new one-time gift.
a payment on an existing pledge.
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I'd like to make a gift to benefit GCSW:
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Amount
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$
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| To make an additional designation, please do so below: |
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$
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| Total Gift: |
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$
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| Total (Gift + Registration): |
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$
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Please let us know below if you would like to further designate your support (for example,
specific scholarship/fellowship, or in honor or in memory of someone) or give us any other
special instructions about your gift.
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This Gift is:
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In Memory of:
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In Honor of:
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Personal Information:
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* Title:
* First Name:
Middle Name: |
| * Last Name:
Suffix:
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