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Geological Society of America Foundation

Form to Donate by Fax or Mail:

(fill out this form and print, then fax or mail - sending info below)

Gift Amount and Fund

I want to make a contribution of

$

Where do you want your contribution to go?

Contact Information

* E-mail Address


I may be contacted by email
Please do not contact me by email

Title

*First Name

* Last Name

Middle Initial

Suffix

Street Address

City

State/Province

Zip/Postal Code

*Country

* Phone Number

Company Name

Spousal Donation

Your donation can go even further. If you or your spouse have a matching donation program at work, make the donation in both of your names and send us the name and address of your (and your spouse's) employer with your gift. We will take care of the rest.

Donation in the name of

My Name Only
My Name and

Employer's Name

Employer's Address

City, State, Zip

Spouses' employer Name

Spouses' employer Address

City, State, Zip

Credit Card Information

* Name


as it appears on the card

* Expiration Date

* Credit Card type

* Card number

* = Required Field

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Checks should be made payable to the GSA Foundation. Please print this form and send it with your payment to:

 

Mail to:
GSA Foundation
PO Box 9140
Boulder, CO 80301

USA

 

Fax to:
303-357-1073