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 Name Last Name

Email: *

Phone Number

Area Code Phone Number

Gift Amount: $

Gift Designation

Alumni Association Scholarship

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?

No Yes

Payment Details *

USD Online 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

City State / Province

Postal / Zip Code Country

Gift Date

Month Day Year

SLCTCRDT

BUID

SOLICITOREMAIL

example@example.com

Honorary or memorial gift?

No Honorary Memorial

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?

Yes No Unknown

Relationship to Belmont (check all that apply):

Alumni Parent Student Faculty/Staff Other / None Lumos 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