Founders Day Challenge

Name*
First Last
Cell Phone*
Email Address*
Address Type*
Preferred Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Chapter*
Grad Year*

Special Instructions
Employer for Matching Gift
Options
- I have included AEPi in my will / would like to include AEPi in my estate planning
- I would like to make my donation anonymously
Dedication*
- No Dedication
- In Honor Of
- In Memory Of
Name
First Last
Acknowledgement
- No Acknowledgement
- Email Acknowledgement
- Mail Acknowledgement
Name
First Last
Email Address
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cover Credit Card Fees
- I would like my entire donation to go to AEPi and will cover the credit card fees
Credit Card Fees
$0.00
Total Donation
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

FOUNDERS DAY CHALLENGE – DONATE