SETOR1-#5812683-v1-Gary_Nachsen_document.DOC



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PLEDGE FORM

in Memory of Professor Dr. Michael Milde

Name ___________________________________________________________________________

Address _________________________________________________________________________

City _______________ State/Province _______________ Postal Code _____________________

Telephone___________________________ Email_______________________________________

I wish to make a pledge to the

□ IASL – General Fund 02802, in memory of Professor Michael Milde

in the amount of (Canadian$)

□$100 □ $250 □ $500 □ other $_________

PAYMENT OPTIONS:

□ Cheque (made payable to McGill University).

□ Credit Card □Visa  □MasterCard □American Express

Name on card__________________________________________________________________

Card number________________________________________Exp._______________________

Cardholder’s signature_______________________________________________________

Signature for pledge______________________________ Date________________________

□ WIRE TRANSFER PAYMENT TO:

|Beneficiary Bank: |Transit code: 00001 |Currency: Canadian $ |

|RBC Royal Bank of Canada |Swift code: ROYCCAT2 |Account name: |

|1 Place Ville Marie |Bank/Branch code: 003 |McGill University |

|Montreal, Quebec |McGill Bank Account Number: 308-101-5 |Please state: |

|H3C 3A9 Canada | |McGill IASL – Milde Fund |

Your pledge form can be sent or faxed to:

Maria D’Amico

Institute of Air and Space Law Association

McGill University

3690 Peel, Montréal QC Canada H3A 1W9

Fax: +1-514-398-8197

Email : maria.damico@mcgill.ca

Disclaimer: For security reasons, please do not sent your credit card information electronically via email, instant messaging, scanned document, etc). Please fax this form to (+1)-514-398-8197.

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5812683 v1

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