Donation and Contribution Form Please select the type of gift you are making I would like to make a contribution for this term’s activities I would like to make a donation to the University for Seniors Fund The amount of my contribution or donation is $ ________________ Your information Name _____________________________________ Address_______________________________________________________________________ Mobile phone________________________________ Work or home phone__________________ Email _____________________________________ Have you participated in the University for Seniors? Past ____ Current ______ Not yet_____ Are you an AUB alumna/alumnus? Yes ______No ________ Your name as written above will be listed in the AUB Contributors Report. If you prefer to remain anonymous please check here. Four ways to make your contribution or donation 1. Bank transfer Bank Name: Citibank, NA Lebanon Account Name: AUB Development Office - Donation Account IBAN: LB16011500000000000600224115 Designation (payment details): University for Seniors Fund Swift Address: CITILBBE 2. Credit Card (via the secure web option https://give.aub.edu.lb/seniors/ or using this form) Please charge $__________________ to my Visa Master Card American Express Card Credit Number: | | | Expiry Date______- ______ Month | | | | | | | | | | | | | | Year My name as it appears on credit card ____________________________________ Signature ___________________________________________________________ 3. Check payable to ‘AUB’ (enclose with form) 4. Cash (enclose with form) For credit card, cash or check payments, please complete this form and send it to Ms. Soha Hmaidan, Director of Development Operations, College Hall 3rd Floor, American University of Beirut, Bliss Street, Beirut. Tel: +961 1 340176