COMMIT TO MULTIPLY

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

I plan to fulfill my commitment: *

Please check all that apply.

As a one-time gift

In equal amounts over two years

By giving a non-cash item (stocks, real-estate, etc.)

If you chose to give a one-time gift, please specify the giving date.

MM

DD

YYYY

If you chose to give equal amounts over the next two years, please choose an option.

Annual Gift

Monthly Gift

Weekly Gift

Beginning on:

MM

DD

YYYY

If you chose to give a non-cash item, please specify.

Stock

Real-Estate

Charitable Gift Fund

Other