80 by 20 Donation Donation InformationWhat kind of donation would you like to make?* One-time gift Annual pledge (5 years) Monthly (12 months) Apply to Pre-existing Pledge One Time Gift Amount* Diamond Patron: $10,000 Benefactor: $5,000 Donor: $3,000 Friend: $1,000 Supporter: $500 Other Other Gift Amount* How would you like to direct your donation?* General Fund Barbara Berci Memorial Fund Do you want to receive a copy of Dr. George Berci’s autobiography?*Receive a copy of Dr. George Berci’s autobiography – The Scope of My Life With your minimum $25 donation to the Foundation. Yes, please mail me a physical copy-US addresses only Yes, please send me the ebook version. No, thank you. How many books would you like?*You are entitled to 1 book per $25 donation. Would you like a signed copy?* Yes No What is the recipients' name - You may enter more than one name for multiple copies:* To what address should the book(s) be mailed?* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code 5 Year Pledge*Your first payment will be charged immediately and subsequent payments charged yearly for the next four years. Diamond Patron ($10,000 total/$2,000 per year) Benefactor ($5,000 total/$1,000 per year) Donor ($3,000 total/$600 per year) Friend ($1,000 total/$200 per year) Supporter ($500 total/$100 per year) Apply to existing Pledge* Diamond Patron ($10,000 total/$2,000 per year) Benefactor ($5,000 total/$1,000 per year) Donor ($3,000 total/$600 per year) Friend ($1,000 total/$200 per year) Supporter ($500 total/$100 per year) Other Other Pledge Payment* Monthly Donation Amount*SAGES will charge the amount below monthly for the next 12 months. Donor InformationDonor Name* Prefix Mr.Mrs.MissMs.Dr.Prof.Rev. 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