Attend the 2019 Valenti Impact Awards May 2, 2019 at the University of Houston 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. * I would like to: Attend the Event: $1000 Valenti Impact Sponsor ($500 FMV) # $ Valenti Impact Sponsors include 10 tickets to the event. Impact Sponsors also receive special recognition at the banquet. I would also like to make a gift to benefit the following: Valenti Excellence Fund - UnrestrictedValenti Scholarship FundWelcome Wilson Scholarship $ I'd also like to make a gift in support of: $ Total (Gift + Registration): $ Additional Attendee(s): If you purchased more than one ticket, please type the name(s) of the additional attendee(s) This gift is in memory of: This gift is in honor of: Personal 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 Sargeant Sargeant Major Sister Sister The Honorable The Most Reverend The Reverend * First name: Middle name: * Last name: Suffix: * Address: * City: * State: * 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: 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 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: 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 the 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.