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.





Name (please print)                                                            Signature                                                                                                




Mailing Address





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