CBC DonationForm Dec2012

Department of Chemistry and Biochemistry
Yes! I would like to support CBC @ UA! My gift for $ _ ___________ is enclosed. Please make checks payable to The University of Arizona Foundation. If your employer has a matching gift program, your support to the Department of Chemistry & Biochemistry (CBC) could be increased. Please contact your company’s personnel office for the necessary form and enclose it with your gift. My gift qualifies for corporate matching from _ _______________________________________________________ If you would like to direct your gift to a specific CBC Department program, please check the appropriate box below. CBC Development: To support department functions, staff, faculty, and/or student endeavors. Awards: Student, faculty, and staff awards for performance and service. Departmental Needs: Graduate recruitment, undergraduate support, outreach, seminars, faculty/staff advancement, retreats, etc. Faculty ‐ Endowed Chairs & Professorships Student Scholarships & Fellowships If you want your gift to go to a specific existing gift account, please check the appropriate box below. Carl Marvel Research Scholarship David O'Brien Graduate Fellowship Dr. Harold McNair Staff Awards Ernest Polak Biological Sciences Scholarship Herb Carter Award Homer & Emily Weed Endowed Chair Homer & Emily Weed Endowed Lectureship John P. & Helen Schaefer Endowed Chair Lela Booher Memorial Scholarship Michael A. Cusanovich Endowment Michael A. Wells Undergraduate Research Scholarship Robert Davis Lectureship Per IRS regulations, your contribution is 100% tax deductible. Please consult your tax expert for details. If you would like information about making a planned gift, contact Bob Logan at 520.621‐4015 or [email protected]. Thalacker Graduate Fellowship in Chemistry Victor Hruby Fellowship Wayne Cody Medical Biological Chemistry Scholarships Name _ ________________________________________________________________________ Date _ ____________ Address _ _____________________________________________________________________ Phone _ ____________ City _ _______________________________________________________________ State _ _ Zip Code _ _______ E‐mail _ ______________________________________________________________________________________________ I give my permission to have my name listed as a donor in the Chemistry & Biochemistry Newsletter. Please initial: yes no Mail with your payment to: ATTN: Ms. Ellie Warder Department of Chemistry & Biochemistry The University of Arizona P. O. Box 210088 Tucson, AZ 85721‐0088 Revision 19‐Dec‐2012 (RLM)