American Name Society

YES, I would like to contribute to the Kelsie B. Harder Memorial Fund.  I understand that my contribution will be used in support of the educational programs of the American Name Society.

 

 

 

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Name (please print)                                                            Signature                                                                                                

 

 

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Mailing Address

 

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Email (optional) _______________________________________  

 


Please make checks payable to The American Name Society or

 

To contribute by Credit Card please complete the following:

 

Please Charge my Credit Card as follows:

 

Check One:

Amount in U.S. Dollars: ________________

 

Card Number: _____________________________  Expiration Date: ______________

 

Name (please print as shown on card):________________________________________

 

Signature: ________________________________________________________

 


 

Print and complete this form and send it to:

Michael F. McGoff, Vice Provost

Office of the Provost

Binghamton University

State University of New York

Binghamton, New York 13902-6000