formerly University of Missouri-Rolla
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Office of Annual Giving/
Miner Phonathon
112 Campus Support Facility
Rolla, MO 65409-1320
Phone: 573 - 341 - 6376
Fax: 573 - 341- 6683
phoneus@mst.edu

Blank Pledge Form

PLEASE PRINT THIS FORM AND

MAIL TO: DONALD J. KEENEY ANNUAL GIVING / PHONATHON 112 CAMPUS SUPPORT FACILITY ROLLA , MO 65409-1320 OR FAX TO (573) 341-6683

 

 

Thank you for your gift to the University of Missouri - Rolla.
Our success in educatingtomorrow's leaders depends on the support of our alumni and friends.

I / We support the University Of Missouri-Rolla with a
gift of $_____________________ for the ________________ department

Company matching gift form enclosed

My Name: ___________________________________________________________
My Address: _____________________________________
_____________________________________

Phone: ______________________________________

 (If Paying by check)
Please make your check payable to the Missouri University of Science and Technology.
Your gift to Missouri S&T qualifies as a charitable tax deduction as allowed by law.
Gifts of $250 or more will be formally receipted in keeping with IRS
regulations, as will credit card payments.
(If Paying By Credit card) Please charge to       Visa      MasterCard    Discover   

Expiration Date Of Credit Card: ____________________________ Account #:_______________________
Signature:_______________________

 

DEPARTMENT NEWS  Your news may be published in your departmental newsletter and / or the MSM-Missouri S&T Alumnus magazine . PLEASE PRINT