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Campaign Pledge Agreement
Title:
First name:*
M.I.
Last Name:*
Suffix
Graduation Year:*
I accept the invitation to join others in support of our Fraternity in its ideals of Friendship, Justice, and Learning, and do hereby pledge and agree to contribute to Delta Chi for use in the Capital Campaign.*
Enter total amount of pledge above
My Gift Shall Be Made To:

Delta Chi Educational Foundation: For tax-deductible contributions to the Delta Chi Educational Foundation: make your check payable to Delta Chi Educational Foundation and note Cornell Chapter of Delta Chi Campaign on the memo line. The foundation is recognized under section 501(c)(3) of the Internal Revenue Code, tax ID # 35-2120949.Delta Chi Housing Corporation: For non-tax deductible contributions make your check payable to the Delta Chi Housing Corporation and note Capital Campaign on the memo line.
My gift will be paid in the following manner:*

One-Time PaymentQuarterly (Jan/April/July/Oct)Semi-Annually (Jan/July )Semi-Annually (April/Oct)AnnuallyMonthly
My gift will be paid over the following number of years:*

12345Other
Start Date:*

JanAprilJulyOctoberOther
Start Year*
Notes:
Electronic Signature: First and Last Initials AND your Birthdate (i.e. EH0913)*
Gift to be made:*

In my name printed aboveIn memory of: (please enter name below)In honor of: (please enter name below)Other
Contact Information
Address*

Street address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Preferred Postal Address*

HomeWork
Home Phone*
Work Phone
Cell Phone
E-mail*
Employer
Position
Payment Information
Payment Method*

Check - Make check payable to Delta Chi Housing Corp- Cornell, noting campaign on the memo line.Stock: Contact the campaign administrative office for instructions.Credit Card: Accepted by House Corporation: (Discover/MasterCard/Visa)Credit Card: Accepted by Educational Foundation:(American Express/Discover/MasterCard/Visa)Other
Note: To ensure your Credit Card security, please call the campaign office to provide your card information.
Mail All Forms and Payments to:

The Campaign for Delta Chi

The Cornell Chapter of Delta Chi

PO Box 876

Ithaca, NY 14851-0876
Thank you so much for your pledge and support for The Cornell Chapter of Delta Chi's Securing Our Leadership for the Next 125 Years Campaign.
If you have any questions, or for further information, please contact:

Dorothy Wysocki

Advancement Services Coordinator

dwysocki@elevateims.com / 607-533-9600, ext. 224
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