Give Back Campaign
Contribution Form

Name_______________________________________ Graduation Date______

Address_________________________________________________________

City_______________________________________ State______ Zip________

Phone (W)_______________________ Phone (H)_______________________

Email:___________________________________________________________

Categories of Giving

[  ] To $249   Pledge Builder
[  ] $250 - $499  Norman Shield     
[  ] $500-$999 Jordan Standard 		 [  ] $1000-$4999 Prof Scheuch
[  ] $5000-$9999 Constantine
[  ] $10,000 & Up  White Cross

Giving Options

[  ] One Time Contribution
[  ] 1/3 now; 1/3 next year; 1/3 in 2 years
[  ] 1/2 now; 1/2 next year
[  ]  Other________________________________________________________

Mail Contribution Payable to:

Sigma Chi Building Foundation
PO Box 8874
Missoula MT 59807