The History Center Gift Form

Gift Information

Gift Amount:

If "Other" enter a specific amount: $

Gift Designation:

If "Other" please specify:

Personal Information

First Name:

(required)

Last Name:

(required)

Address (line1):

(required)

Address (line2):

City:

(required)

State or Province:

or (required)

Zip / Postal Code:

(required, please do NOT use hyphens)

Country:

(required)

Home Phone:

- - (required, please include area code)

Work Phone:

- - (please include area code)

E-mail:

(required)

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Your gift will support education programs, research library/archives, exhibitions, collections preservation and conservation. All contributors to The History Center will be acknowledged in our annual report unless otherwise informed.

Recognize Others with Your Gift

Make my gift ...

in honor of...

in memory of...

First Name:
Last Name:
	An acknowledgment of this gift should be sent to:
Name:
Address:
	Is there anything else you'd like us to know about the person(s) you are recognizing?

Matching Gift Information

Do you work for a company that matches gifts to not-for-profit organizations?

Matching Company?

(1) I am eligible for matching funds through my employer and will send you the form for processing

(2) I have applied directly with my employer for matching funds

(3) I am unsure if my employer matches gifts

(4) My employer does not match gifts

Employer Name:

(If you choose #2 or #3 above)

You can double or triple your gift to The History Center if you or your spouse/partner works for one of over 1,000 companies that provide matching gift funds to charitable organizations. Check with your Human Resources office and send completed matching gift form to:

The History Center in Tompkins County
Matching Gift Program
401 East State Street
Ithaca, NY 14850