West Chester University Foundation
Frederick Douglass Statue
Name______________________________________________________________________________Class Year______________________
Address___________________________________City________________________________State____________________Zip__________
Phone (______) _____________
Email Address __________________________________________
I would like to make a one-time gift of $____________ to the Frederick Douglass Statue Fund. My gift is enclosed.
I would like to make a one-year pledge of ___________ and pay in four quarterly credit card payments of
Please charge my credit card:  Visa  MasterCard
 AMEX
_______
Acct.# ________________________________________
Signature _______________________________________________
Name on card __________________________________________
Exp. Date ________________Sec. Code__________
My gift is eligible for a corporate match from:
 my employer or  my spouse’s/partner’s
Co. Name_________________________________________
Please make checks payable to West Chester University Foundation.
You may also give online at www.wcupa.aedu/giving.
For additional information, please call 610-436-2868.