SIMON FRASER UNIVERSITY
2008 CAMPUS CAMPAIGN
Name
Address
City, Province
Phone Number
Department
Postal Code
Email
 YES, I WANT TO SUPPORT STUDENTS AT SFU!
ENCLOSED IS MY GIFT/PLEDGE OF:
$150  $200  $350  $500
 Other $ __________
PLEASE DIRECT MY DONATION TO:
 The following scholarship or bursary
 Improvements to Student Space on campus (select one):
 AQ Concourses
 Library (6th floor student space)
 Campus Community Bursary Fund
 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.
PAYMENT OPTIONS
A. PAYROLL DEDUCTION (faculty and staff only)

I authorize continuous bi-weekly deductions of $


Please increase my bi-weekly deductions from $
to $
starting on
Deduct $
X
pay periods starting on
SFU ID # (required for payroll deduction)
Signature
B. ALTERNATIVE METHOD OF PAYMENT

Cheque (payable to Simon Fraser University)

VISA

MasterCard

Account #
Cardholder’s signature
CREDIT CARD GIFTS BY INSTALLMENT

All at one time

Ongoing monthly payments of $

starting on
(deductions will continue until otherwise notified)
American Express
Expiry Date
__/
starting on
__
15th, 2008.
(month)
I would like to arrange other installment terms, please contact me.
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.
PRIVACY STATEMENT
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 778-782-3093.
Please return form to:
SFU, University Advancement, 2118 Strand Hall, 8888 University Drive, Burnaby, BC V5A 1S6