The Rhine
RESEARCH CENTER


So that others may benefit from the work of the Rhine Research Center, I accept this commitment to the "Taking Flight Society" for five (5) successive years!

Please list me (us) as a contributor at the following annual donor level:

	o $100 - $299	o $600   -  $999	o  $5,000  -  $9,999
	o $300 - $599	o $1,000 -  $4,999	o  $10,000+

I (we) understand that this commitment will continue at the specified rate below for each of five (5) years; that is, my (our) total agreement is $________________ payable in five (5) annual installments at a rate of $_____________ per year.*


My company, ________________________________________ will provide a "Taking Flight Society" MATCHING GIFT!

COMPANY NAME________________________________________

please contact _____________________________________ at (________) 



I am providing my current contact and payment information;
I will inform you of any changes as they occur in the future.   

_____________________________________________   (_______)______________________
FIRST NAME	MIDDLE INITIAL	LAST NAME	HOME PHONE

______________________________________________	(_______)______________________
MAILING ADDRESS					WORK PHONE

______________________________________________	(_______)______________________
CITY	STATE	ZIP CODE + 4			CELL PHONE

_________________________________ ________________________________________
EMAIL ADDRESS			  WEBSITE URL


Enclosed is my (our) first annual installment in the amount of $___________________.

* CHECK - Payable to Rhine Research Center
* CREDIT CARD - Master Card and Visa Only

* One-Time (first installment only) Credit Card Charge
* Annual Credit Card Charge (5 installments - 1 per year) According To My Agreement
 _ _ _ _    _ _ _ _     _ _ _ _     _ _ _ _
|_|_|_|_|  |_|_|_|_|   |_|_|_|_|   |_|_|_|_|	_____|_____(MM|YY)
CREDIT CARD NUMBER					EXPIRATION DATE


_________________________________________________________	 
MY SIGNATURE	


Your generous commitment to the "Taking Flight Society" in support of The Rhine is appreciated. We maintain the privacy of your information. Keep a copy of this pledge form for your records. For information, contact Office of Institutional Advancement.


2741 Campus Walk Avenue    Building 500    Durham, North Carolina 27705-8878
Phone: 919-309-4600  Fax: 919-309-4700  Email: information@rhine.org  Web: www.rhine.org