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 Payment
Quarterly (Jan/April/July/Oct)
Semi-Annually (Jan/July )
Semi-Annually (April/Oct)
Annually
Monthly
My gift will be paid over the following number of years:
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1
2
3
4
5
Other
Start Date:
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Jan
April
July
October
Other
Start Year
*
Notes:
Electronic Signature: First and Last Initials AND your Birthdate (i.e. EH0913)
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Gift to be made:
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In my name printed above
In memory of: (please enter name below)
In honor of: (please enter name below)
Other
Contact Information
Address
*
Street address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
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Lithuania
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Macau
Macedonia
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Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
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Singapore
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Slovenia
Solomon Islands
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Spain
Sri Lanka
Sudan
Suriname
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eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
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Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
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Turkey
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US Virgin Islands
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Western Sahara
Yemen
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Zimbabwe
Other
Country
Preferred Postal Address
*
Home
Work
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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