Form A - SAIS Europe



SAIS Europe

Contribution/Pledge Form

Preferred mailing/contact address: home business

I will make a total gift of ______________ over ______________ year(s) and through yearly payments

of ______________ starting on _____________________________

Designation: ___________________________________________

I will make my payment(s) by way of:

cheque payable to “Johns Hopkins University”. ALWAYS attach a copy of this form and mail them to the address below.

Credit card: Visa MasterCard American Express Discovery

Card number: *Val. Number:

Exp. Date: ____/____ Name on card ____________________________________

* Validation number is a 3-digit number printed on the back of your Visa or MasterCard. For American Express, it is a 4-digit

number printed on the front right side

I will send my gift to __________________________________________________________________________

** only for tax efficient gifts in these countries

My company will match my gift. Company name_______________________________________________________

In compliance with the Legislative Decree no.196/2003, your personal data will be used by the Johns Hopkins University SAIS Europe for the processing of your gift and university related communications. The data will be treated by SAIS Europe and by the subjects in charge of: data processing and information systems, development and other related activities. You can always consult, modify or delete your data by writing to sais.eu.privacy@jhu.edu

Donor’s signature: _______________________________________ Date: ______________________

Please return this form to SAIS Europe Development Office – Johns Hopkins University, Via Beniamino Andreatta 3 già via Belmeloro 11, 40126 Bologna

Tel. +39/051/2917821 Fax. +39/051/228505 sais.eu.development@jhu.edu

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US dollars

Euro

num. of years (max 5)

amount

US dollars

Euro

year, month

amount

Entity’s name: Associazione Italo-Americana (Italy), UK Charitable Trust (UK), Fondation de France (France), Verein der Freunde der JHU SAIS Europe (Germany), King Baudouin Foundation (Belgium), The Foundation for Poland (Poland), Swiss Philantropy Foundation (Switzerland))**

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