Lycoming

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Gift Designation

If Other, please explain:

Warrior Club Gift Designation

First Name

Last Name

Phone Number

Address

City

State

Zip

Class Year

Apply this gift to my current pledge.

This gift is in honor of:

Name of the person you are recognizing

This gift is in memory of:

Name of the person you are remembering

Please make me anonymous.

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Card Number

Expiration Date

CVV

I’d like to add 3.5% to cover processing expenses.

Donor hereby approves the payment of the charitable donation and/or purchase to Lycoming College and in the amount set forth herein.

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