Give Online Now I would like to make: a new one time or recurring gift a payment on an existing pledge * Frequency: One time Weekly Monthly Quarterly Annual Recurring Amount: $ Start Date: End Date: Your recurring gift will be split between multiple colleges and/or programs accordingly below. Color Splash - Blaffer Art Museum Gala, April 1 - 7:00pm to Midnight I would like to purchase a table at the following level: Purple Corallites - $25,000 (FMV $1,500) Fiesta - $15,000 (FMV $1,500) Blue Jewel - $10,000 (FMV $1,500) Hemlock - $5,000 (FMV $1,500) $ I would like to purchase individual tickets: Purple Corallites - $5,000 per Person # $ Fiesta - $2,000 per Person # $ Blue Jewel - $1,000 per Person # $ Hemlock - $500 per Person # $ I am unable to attend but would like to make a fully tax-deductible contribution of $ Please provide your name as it should appear on printed material If you have any questions regarding Color Splash please contact Taylor A. Harrell, Director of Special Event and Patron Relations at firstname.lastname@example.org, 713-743-1304 Special Giving Opportunities I would like to purchase/renew my membership at following level: Artist/Student Member $25Individual Member $40Dual/Household Membership $75Blafferite Member $150Art World Insider $250Blaffer Connoisseur $500Founding Member $1000 $ I would like to purchase a gift membership at the following level: Artist/Student Member $25Individual Member $40Dual/Household Membership $75Blafferite Member $150Art World Insider $250Blaffer Connoisseur $500Founding Member $1000 $ Please provide the name of the recipient you would like to purchase a membership for: I would like to purchase a Paver at the following level: $500 for 18 inch each paver#$ $750 for 24 inch each paver#$ Please provide the text exactly as it should be engraved (50 characters max.): Giving Opportunities * I would like to make a gift to benefit the following: Blaffer Annual FundExhibitions and ProgramsMuseum RenovationYoung Artist Apprenticeship ProgramOther $ Total gift amount: $ Please let us know if you would like to designate your gift further (for example, to a department within a college or in honor or memory of someone) or give us any other special instructions about your gift. This gift is in memory of: This gift is in honor of: Donor Information Title: Please choose... Airman First Class Baron Brigadier General Captain Colonel Dean Doctor Father First Lieutenant General Governor Judge Lieutenant Lieutenant Colonel Lieutenant Commander Major Miss Mr. Mrs Ms. Professor Rabbi Sergeant Sergeant Major Sister The Honorable The Most Reverend The Reverend * First name: Middle name: * Last name: Suffix: * Address: * City: * State/Province: * Zip code: * Country: * Phone number: * Email address: Date of birth: Spouse's full name: Status: UH Alumnus UH Faculty/Staff UH Student Neither UH degree: Graduation year: * Peoplesoft ID: Matching Gifts Did you know you can double or triple your gift if you or your spouse work for a company with a matching gift program? Learn whether your employer has a matching gifts program. You may also contact your Human Resources Department directly. Do you or your spouse work for a matching company? Yes No I work for a matching gift company Company name: My spouse works for a matching gift company Spouse's company name: Send your completed matching gift form to: Matching Gift Administrator Gift Processing and Records University of Houston Houston, TX 77204-5035 Business Information Please help us keep your record up to date. Would you like to update your business information? Yes No Job title: Employer: Address: City: State/Province: Zip/Postal code: Country: Phone number: Email address: Planned Giving Have you already or would you like to include UH in your estate planning? Yes No I have already included UH as a beneficiary of my: Will Trust Life Insurance Policy Retirement Assets Annuity IRA Please send me information for the following: Bequest Language Membership in The Tempore Legacy Society Ways to Make Planned Gifts Charitable Gift Annuities Estate Planning Kit Information provided on this form will be used by University Advancement for the purpose of crediting you correctly for your gift. Personal information contained in University Advancement's records is used only for university business. We are committed to protecting your privacy. Our secure server software (SSL) is the industry standard and among the best software available today for secure commerce transactions.