Fall Luncheon featuring the Quorum Report’s Harvey Kronberg Thursday, September 4, 2014 Benefitting the 2015 Hobby Fellows-Austin Internship Program Donor Name: ____________________________________________________________________________________ Last First MI Mailing Address: _________________________________________________________________________________ Street City State Zip Billing address, if different from above: _______________________________________________________________________________________________ Street City Phone: (____) ____ - ________ Day (____) ____ - ________ Evening State Zip E-mail:____________________________________ Yes, I would like to support the HCPP Fall Luncheon by becoming a sponsor: $5,000 Governor Level $2,500 Lieutenant Governor Level I am unable to participate as a sponsor but please accept my donation in the amount of: $____________ Payment Information Enclosed is my check in the amount of $ __________ (made payable to University of Houston). Please charge my credit card for the amount of $ _____________ . Account Number: ___________________________________________ Expiration Date: _____________________ Name as it appears on card: _______________________________________________________________________ Signature: ______________________________________________________________________________________ Please contact me about fulfilling my gift with a gift of appreciated securities. Recognition I give the University of Houston permission to publicly acknowledge my gift in UH print and online publications. Yes No My name should appear as follows: _________________________________________________________________ Matching Gifts My gift will be matched by: ________________________________________________________________________ (Please specify company name for our records.) Donor Signature: ________________________________________________ Hobby Fellows – Austin internship program (HC50971RN) Date: _________________________ appeal code (AHBGN) Thank you for your support of University of Houston and the Hobby Center for Public Policy! University of Houston, College of Liberal Arts and Social Sciences, ATTN: Ellen Happe Phillips, Office of Development 402 Agnes Arnold Hall, Houston, Texas 77204-3000