Donor Information
     
     
First Name Last Name
     
 
Alternate / Maiden Name Spouse Name  
   
 
Address Apt / Suite
     
     
City State Zip
     
This is a new address    
     
E-Mail:    
     
Home Phone:  
Cell Phone:  
Work Phone:  
     
I am an alum:
  Grad Year / Years Attended School Name
My spouse is an alum:
  Grad Year / Years Attended School Name
     
Donation Information
     
Designations: May be split, but must equal the total donation amount.  
Celebrate Life 2011: $  
Where most Needed: $  
Student Scholarships $  
Campus Development: $  
Endowment: $  
     
Other: $ (if you choose Other, please fill in the field)
Other Designation    
The Other field allows you to designate your gift to a specific department, program, or endowed scholarship fund.

Total Amount:
  		  
 
This gift is a:
 
Type of gift:
 
 
The first payment of your recurring gift will be charged today. The Coordinator of Advancement Services will contact you to confirm your recurring gift request.

Memorial and Honorary Gift Information
If you would like to pay tribute to a special person with your gift, please fill in the fields below.
A Memorial Gift in Honor of:
   
An Honor Gift in Recognition of:
   
In the space below, please list the name(s) and address(es) of anyone you would like us to notify of your tribute gift.

 

 

By clicking Continue, I authorize Life Pacific College to charge my account as indicated above. My enrollment will remain in effect until I notify Life Pacific College that I wish to end this agreement, which I may do at any time. I will also notify Life Pacific College of any changes in my account information.

 

If you would like to modify your existing automatic monthly gift, please call the Office of Advancement at (877) 866-5433.