Gift # 1 - College, Center or Institute:

--Select from List-- Area Health Education Centers Arkansas Cancer Research Center College of Medicine College of Health Related Professions College of Pharmacy College of Nursing College of Public Health Graduate School Jones Eye Institute Myeloma InstitutePschiatric Research Instit. Reynolds Institute on Aging Stephens Spine Institute UAMS Medical Center $

     (Optional) Please designate your gift to an established UAMS Foundation fund. Check with your Development Officer to determine a fund name. If you don’t have this information, please note the specific Department, Area, Program or Scholarship. If no area is designated, your gift will be placed in the area of greatest need.
    

Gift # 2 - College, Center or Institute:

     (Optional) Please designate your gift to an established UAMS Foundation fund. Check with your Development Officer to determine a fund name. If you don’t have this information, please note the specific Department, Area, Program or Scholarship. If no area is designated, your gift will be placed in the area of greatest need.
    

Gift # 3 - Area of Greatest Need:

$

TOTAL

$

Step 2: Designate gift # --Select-- 1 2 as an Honor or Memorial gift.
If you would like to designate multiple gifts as honor or memorial gifts, please inform us in the Comments section below.

My gift is:

In Honor of 

In Memory of 

Please provide the names and addresses of anyone that should be notified of your gift.
Name 1: Address 1:

Name 2: Address 2:

Step 3: Find out if your gift will be matched by your employer.

Many employers sponsor matching gift programs and will match any charitable contributions made by their employees. To find out if your company has a matching gift policy, please click on the link below.

http://www.matchinggifts.com/uams

If your company is eligible, please follow the provided directions to make your gift. The impact of your gift to our organization may be doubled or possibly tripled! Some companies match gifts made by retirees and/or spouses.

Step 4: Provide your Personal Information.

* Indicates a required field.

Title:

Dr. Mr. Mrs. Ms. Miss

First Name: *

Middle Initial:

Last Name: *

Address1:*

Address2:

City, State: *

  --Select From List-- N/A Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code: *

- ( optional)

Telephone: *

Area Code -

E-mail Address: *

(Optional) Step 5: If you are employed by UAMS, please provide your work information.

Primary Work Area

--Select from List-- Academic Affairs and Research Administration Administration and Government Affairs Area Health Education Centers Arkansas Cancer Research Center Budget and Planning Campus Operations College of Medicine College of Health Related Professions College of Pharmacy College of Nursing College of Public Health Communications & Marketing Development and Alumni Affairs Financial Administration Graduate School Reynolds Institute on Aging Information Technology Jones Eye Institute Myeloma Institute Psychiatric Research Instit. Regional Programs Stephens Spine Institute Support Services UAMS Medical CenterOther

Department or Division

Comments: