____ Yes, I/we would like to become members of the 1835 Society and participate in the $1,000,000 Baird Challenge.

____ My/Our gift will be matched by ______________________________________.

____ I/we would like to make this commitment for ___ one year ___five years (check one)

Name _____________________________________________Class Year ________

Address ____________________________________________________________

Telephone_____________________________  Email ________________________

Signature___________________________________________Date ____________

For credit card gifts, please complete the following.

Name on card ________________________________________________________

Please check: ______ Visa   ______ Mastercard  ______ Discover

Amount: ____________________________________________________________

16-digit credit card number: _____________________________________________

Expiration Date: ______________________________________________________

3-digit CVV number (printed on back of card) _______________________________

Signature __________________________________________________________

Please mail this form to: Institutional Advancement, 1835 Society, 611 E. Porter Street, Albion, MI 49224 and you will be contacted to establish the details of your gift arrangement.