R
N
H
SFU C APITAL C AMPAIGN
2006 C
C

Y ES , I WANT TO SUPPORT STUDENTS AT SFU!
E NCLOSED IS MY GIFT / PLEDGE OF :
 $150  $200  $350  $500  Other $ __________ to be paid over ________ year(s).
P LEASE DIRECT MY DONATION TO :
 Campus Community Bursary Fund  Library Special Project
 Other (please specify department, office, program, project or athletic team)
To designate your gift to more than one area, write allocation amount beside areas of choice.
P AYMENT OPTIONS
A.
P AYROLL D EDUCTION (faculty and staff only)
 I authorize continuous bi-weekly deductions of $
(deductions will continue until otherwise notified)
 Deduct $ X
ID # (required for payroll deduction)
Signature
starting on
pay periods starting on
B.
A LTERNATIVE M ETHOD OF P AYMENT
 Cheque (payable to Simon Fraser University)
 VISA 
Account #
MasterCard
Cardholder’s signature

C REDIT C ARD G IFTS BY I NSTALLMENT
 All at one time
American Express
Expiry Date
 ____ monthly payments of $ starting on
(month)
 I would like to arrange other installment terms, please contact me.
__/ __
1st, 2006.
Your donation qualifies for a tax receipt. Receipts for payroll gifts are included on T-4 slips; University Advancement will issue receipts for cash gifts. Charitable Business Number #118520725RR0001
 I prefer that my gift remain anonymous.
 Please send me information about including SFU in my will.
P RIVACY S TATEMENT
At Simon Fraser University, your privacy is our priority. We adhere to all legislative requirements with respect to protecting privacy. We collect your information under the University Act to administer our university advancement program and fundraising campaign. The information we collect is used only to process donations, keep people informed about our activities, and ask for support to further our work. We do not disclose your information to other organizations. If at any time you wish to be excluded from any such contact, or if you have any questions about our privacy policy, please contact Wanda
Dekleva at (604) 291-3093.
Please return form to:
SFU, University Advancement, 2100 Strand Hall, 8888 University Drive, Burnaby, BC V5A 1S6
EMAIL