THOMAS H. KEAN
READING ROOM & GALLERY
I would like to support the Thomas H. Kean Reading Room and have my name included in the patio!
Donor
____________________________________________________________________________________________
First Name
Maiden Name
Last Name
____________________________________________________________________________________________
Street
City
State
Zip Code
____________________________________________________________________________________________
Home Phone
Email
Choose paver size:
□ 4 x 8 ($500 donation required)
□ 12 x 12 ($1,000 donation required)
Indicate below how you would like your inscription to appear. Please print neatly, using one box for each
letter, space or punctuation mark. Kindly note, 4 x 8 paver has a maximum of 13 character spaces per
line; 12 by 12 pavers can accommodate a maximum of 16 character spaces per line.
____________________________________________________________________________________________
Signature
Date
Requests will be processed in order of receipt. Form and payment must be received by June 30, 2012.
Gift
$500 (4” x 8” brick)
Enclosed is payment in full
$1,000 (12” x 12” brick)
Fund for Drew $ _______________
Enclosed is partial payment (at least 50% of total, final payment due by 6/30/13)
Check made payable to Drew University
Credit Card
Visa
MasterCard
American Express
____________________________________________________________________________________________
Card Number
Expiration Date
Security Code
____________________________________________________________________________________________
Name as it appears on card
Return form to: University Advancement, Drew University, 36 Madison Ave, Madison, NJ 07940.
Attach sheet with your message to Tom Kean which will be forwarded as submitted. Questions? Contact John
Holden, Director of Alumni Giving at 973.408.3782 or [email protected].