Lumos Travel Award Online Gift Form

Lumos Travel Award Fund

No good or services will be received, and all gifts to the Lumos Travel Award Fund are tax deductible to the fullest extent of the law.
Name

First NameLast Name
Email:*
Phone Number

Area CodePhone Number
Gift Amount: $
Gift Amount: $
Gift Designation

Alumni Association ScholarshipOther
Area of Support (See next box for fund list):
Gift Designation (Scholarships):
Gift Designation (Missions):
Gift Designation (Athletics):
Gift Designation (College Funds):
Gift Designation (All):
Designation:
Is this a pledge payment?

NoYes

Payment Details*

USDOnline Giving

Payment Information

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Is home address different than billing address?
Home Address (if different than Credit Card address):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gift Date

MonthDayYear
SLCTCRDT
BUID
SOLICITOREMAIL
example@example.com
Honorary or memorial gift?

NoHonoraryMemorial
In Memory of:
In Honor of:
Name and address of person to be notified of this gift:
Will your employer - or your spouse's - match this gift?

YesNoUnknown
Relationship to Belmont (check all that apply):

AlumniParentStudentFaculty/StaffOther / NoneLumos Recipient
Special instructions:
Please verify that you are not a robot*
No goods or services will be received from this gift. The full amount is tax-deductible to the fullest extent of the law.
1900 Belmont Blvd, Nashville, TN 37212

www.belmont.edu

615-460-5517
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