Washburn Law Annual Fund Donation Form

Print and complete this form and mail with your check or credit card information to:

Washburn University School of Law
Advancement Office
1700 SW College Ave.
Topeka, KS 66621-1140

Name:     ___________________________________________

Class of: _________

Firm/
Business: ___________________________________________

Address:  ___________________________________________  Home/Work
          Street

          ______________________________________________
          City               State                 Zip

Phone:    ______________________________________________
          Home                       Work

E-mail:   ____________________________________________  Home/Work

___ I have remembered the School of Law in my estate plan
___ Please contact me regarding planned giving opportunities
___ Please also credit my spouse, ___________________ Class of ______
___ I do not wish to be listed in the donor honor roll

Gifts to the current Annual Giving Campaign must be received
no later than June 30.

I would like to make my gift in the form of:

___ Charge $_______________ to Visa / MasterCard / Discover / Am Ex

Account No: _______________________________  Expiration ______________

Signature: ___________________________________________

___ Check $_______________
(Please make checks payable to Washburn Law School Foundation)

___ Pledge $_______________
(unless you request otherwise, we will send quarterly reminders of
your pledge balance)

___ Matching Gift $_______________ from your company or firm:

    ______________________________________________

___ Washburn Endowment Association Monthly Payment Plan
    Authorization
Yes, I want to ensure that my donation is even more cost
effective. I authorize the Washburn Endowment Association and
my financial institution to initiate entries, as indicated, to
my checking/savings account. This authority will stay in effect
until the date I select or notify you in writing with a 10 day
notice to afford the financial institution a reasonable
opportunity to act on it. Please attach a voided check for the
purpose of setting up bank and transit numbers. Your payment will
be made automatically on the 10th of the month (or the following
business day). WEA is authorized to adjust the monthly pledge
amount as necessary to reflect the current pledge agreement at
that time.

  Signature: ___________________________________________

  Date______________________________

  ___ Checking  ___ Savings Account #____________________________

  My monthly gift amount of $__________ beginning on ____________

TOTAL CONTRIBUTION $_______________