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To make a pledge, please give the total amount and how often you would like us to charge your credit card.
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Donor Information
*
= required
Given Name
*
Initial
Last Name
*
Maiden Name
(if applicable)
Affiliation
*
<Pick One>
Alumni
Faculty/Staff
Current Parent
Past Parent
Grandparent
Volunteer
Council of Directors
Friend of KIS
Graduating Class Year
(4 digits, if applicable)
Address Line 1
*
Address Line 2
City
*
State/Province
*
Zip/Postal Code
*
Country
*
Daytime Telephone
*
Email
Contact me about Planned Giving Options with KIS.
Are you interested in Volunteering?
Are you registered on the online KIS Alumni Directory?
Recognition
Please indicate how you would like your name(s) to be recognized in our KIS Donor Thank You Listings.
I wish for my name to remain anonymous
Credit Card Information
I would like to contribute:
Preferred Currency
*
<Pick Currency>
Canadian Dollars
US Dollars
Indian Rupees
Australian Dollars
British Pounds
Euros
Swiss Francs
New Zealand Dollars
Hong Kong Dollars
Korean Won
Japanese Yen
Total Donation Amount
*
Please debit my credit card
*
Annually
Quarterly
Monthly
with payment/installments of
(Amount)
One-time Gift
Perpetual Payments?
I wish to pay the installment amount on a recurring basis until further notice
Please keep my credit card details on file for any installment payments
Credit Card Type
*
<Pick Type>
Visa
MasterCard
Credit Card Number
*
Expiry Date
*
<Pick Month>
01
02
03
04
05
06
07
08
09
10
11
12
*
<Pick Year>
2010
2011
2012
2013
2014
2015
2016
2017
2018
Name on Card
*
Child's Full Name & Grade for Student Account
*
(if billed to Student Account)
Designated Gifts
*
I would like this gift to be designated to support:
Unrestricted funds
Other
(Please Specify)
Matching Gifts?
Help Us to Double Your Donation!
Yours |
Spouse |
Organization Name(s)
Yes
, matching form will be sent later
No
, matching not available
Please mail the matching gift form provided by your or your spouse's company to:
Executive Director
Kodai Friends International (KFI)
PO Box 6121
Bloomington, IN 47407-6121
USA
or email kodaifriends@yahoo.com to ensure that KIS will benefit from the doubling of your donation with a corporate matching gift.
In Honor / Memory of
I would like this gift to be in Honor / Memory of:
Name(s)
In Honor
In Memory
Please send an acknowledgment to the address above
or, please send an acknowledgment of my gift to:
Name
Address
Special Instructions
Any special instructions we should know?
Thank You! Your official receipt for US tax purposes will be mailed to the above address.
On-line Donations
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