Pledge Card

THE CLASS 72 LEGACY PLEDGE
UST Faculty of Medicine & Surgery

In support of THE CLASS 72 LEGACY, I pledge to donate $5,000.

I remit $ _______________ now and request that you invoice me in the amount of
$ ___________ Annually  Biannually  Quarterly  Monthly  for ____ years.

Please make checks payable to:

 USTMAAAF. Notate: For THE CLASS 72 LEGACY.
For contributions by credit card:
 Mastercard  VISA  American Express

Card Number: ________________________________   
Expiration: ______________

Name as it appears on the card: __________________________________________

Signature: _________________________________________

Home Address: _________________________________________
__________________________________________
__________________________________________

Phone: Cell _____________________ Home _____________________

“Your team must be the size of your dream.”
Our dream, $250,000. Our team. THE CLASS 72.