First Name Last NameMiddle Initial

Address

City State Zip Code

E-Mail Address

Football

Men's Basketball

Line 1

YES, I would like to receive priority points for my gift (select sport)

NO, I do not wish to receive priority points for my gift

Gifts are 100% tax deductible

Personal Information

Payment Information

Check

Credit Card

Credit Card #

Month Year

Payment Method:

Expiration Date:

Amount to charge today $

Bollard Information

Phone Number

Line 2

Line 3

Please return information to: Gator Boosters, Inc. Attn: Gator Bollard Project P.O. Box 13796

Gainesville, FL 32604 (352) 375-4683 x5000

Each line is limited to 20 characters (including spaces and special characters)

Gator Bollard Project

Membership Name

Letters are 5/8" tall

Bollard Number

1 year, $10,000

2 years, $5,000

Please make checks payable to

Gator Boosters, Inc.

Due to changes in tax law, if points are taken gifts are not tax deductible

Please sign: ______________________________________________