Campaign Pledge Form
I accept the invitation to join my brothers and hereby do pledge and agree to contribute the below amount as part of the Believing in Our Future Campaign for Theta Xi at the Georgia Institute of Technology.
Enter total pledge amount above
My gift will be paid in the following manner:
My gift will be paid over the following number of years:
Electronic Signature: First and Last Initials AND your Birthdate (i.e. EH0913)
Gift to be made:
In my name printed above
In memory of: (please enter name below)
In honor of: (please enter name below)
City, State, Zip
Credit Card (Visa/MasterCard/American Express/ Discover)
For tax deductible gifts(pledges of $5,000 or greater), checks should be payable to:
“Theta Xi Foundation”.
For non-tax deductible gifts(pledges less than $5,000), checks should be payable to:
“Beta Alpha Alumni Association”.
Note: To ensure your Credit Card security, please call our Campaign Communications Coordinator, Brent Yancy, at (770) 903-3987 ext 30326 to provide your card information.
Please send pledge payments to:
Believing in Our Future
The Campaign For Theta Xi at Georgia Tech
P.O. Box 80828
Atlanta, GA 30366
Thank you so much for your pledge and support of Theta Xi!
If you have any questions, or for further information, please contact:
T: 770-903-3987 F: 770-903-3988
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