2008 FRIENDS OF
BRUIN RUGBY DONATION REMIT FORM
I wish to support Friends of Bruin Rugby in the
amount of:
__$100 __$250 __$500 __$1,000 __$2,500 __$5,000
__$10,000 __$25,000 __Other
Payment Details:
Name __________________________________
Phone # (H / W / C) ______________________________
Full Address (H / W)
_____________________________________________________________________
Best E-mail
____________________________________________________________________________
This is a joint gift (Spouse
/ Partner Name) ____________________________________________________
__ Enclosed is my check
for $ ________ payable to “The UCLA Foundation”
__ Please charge $
________ to my credit card __ Visa __ MC __ AMEX __ Discover
Name on Card___________________________________________________________________________
(Please print)
Card # _______________________________________________
Exp _____________________________
Additional
ways to give:
__ Matching Gift: In addition to my personal gift, I have enclosed a
matching gift form.
__ Estate Plan: Please send me information on how I can include UCLA
in my estate plan.
Securities: Please contact the securities coordinator at
310-794-3434 for detailed information.
Please return this form
along with your payment to:
Friends of Bruin Rugby
C/O Gordon Bosserman
2029 Century Park East, 6th
Floor
Los Angeles, CA 90067
Privacy Notice: The 1977 California Information Practices Act requires UCLA to inform individuals asked to supply information about themselves of the following:
UCLA is requesting this information to update the general resource files of its External Affairs Department.
Furnishing the information is strictly voluntary and will be maintained confidentially.
The information may be used by other University departments in the regular course of business but will not be disseminated to others except if required by law.
You have the right to review your own data file.
Inquiries should be forwarded to Assistant Vice Chancellor, Finance and Information Management, 10920 Wilshire Blvd., 9th Floor, Los Angeles, CA 90024.
Donors Consent to Use Personal Information: The University is grateful for the support it receives from alumni, parents, and friends.
One of the ways we express our thanks is by listing the names of donors in web-based and/or print publications.
Should you wish that your name not appear as a donor, please notify us if you have not already done so.
Fiduciary Responsibility of the UCLA Foundation:
The UCLA Foundation is a California non-profit, public benefit corporation organized for the purpose of encouraging
voluntary private gifts, trusts and bequests for the benefit of the UCLA campus.
Responsibility for governance of The Foundation, including its investments, is vested in its Board of Directors.
Recovery of Costs from Private Gifts:
As it is customary with universities and other non-profit organizations across the country,
a onetime gift fee is applied to all gifts to provide essential support necessary to UCLA’s overall operation.
The fee is currently 5%.
Fund
610330
RB004
Thank you for
your tax-deductible gift in support of Friends of Bruin Rugby!