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 make a gift to benefit the following: The National Women's Conference: Taking 1977 into the 21st Century $ The National Women's Conference Luncheon Registration # $ Sandwich selections • Muffuletta vegetarian sandwich • Mediterranean grilled chicken • Roast beef with charred vegetables and pesto hummus • Roasted turkey with spinach and roasted red pepper aioli • Sicilian with black forest ham, salami and pepperoni with tomato-olive tapenade • Walnut chicken salad • Asian chopped chicken salad sandwich Side salads • Sweet chili Asian slaw • Fingerling potato salad • Caesar salad • Garden salad with dressing • Herbed couscous Center for Public History $ Houston History Magazine, Archive, and Oral History $ Welcome W. Wilson Houston History Collaborative Endowment Fund $ Total Gift: $ * 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: 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/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 the university's Office of Development for the purpose of crediting you correctly for your gift. Personal information contained in the Office of Development'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.