FHTC FOUNDATION CONTRIBUTION/PLEDGE FORM

Please complete and submit  form or print and mail to:

FHTC Foundation
3301 W. 18th Avenue
Emporia, KS 66801

Name:
Address 1:
Address 2:
City:
State:
Zip:
E-Mail:		Phone: () -Second partThird part

Please list my name in the following manner:

Are you a graduate of FHTC?	YesNo
If yes, year of graduation
Program of Study	Automotive Technology Business Administrative Technology Computer Program Design & Development Construction Technology Dental Assisting Dental Hygiene Emergency Medical Technician Graphic Arts Technology Health Occupations Technology Hospitality/Culinary Arts Industrial Engineering Technolgy Machine Tool Technolgy Paramedic Power Plant Technology Practical Nursing

Contributions

In support of the FHTC Foundation,
I / We wish to give a gift of $		to be fulfilled through:
Personal check made out to FHTC Foundation
Visa	MasterCard
Discover	American Express

Credit Card Only:

Name as it appears on card:
Account Number:
Expiration Date:

Pledges

I / We wish to make a gift through an annual pledge in the total amount of:

Please bill me:

Annually

Semi Annually

Quarterly

Monthly

Please direct my gift to support

Gifts of any size are greatly appreciated. 

Authorization

I authorize this contribution/pledge:
Signature (please type name)
Date	Date and timeNow

Thank You for your thoughtfulness and generosity!