Valerie Gregg International Student Fund Donation Form

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Donate to the Valerie Gregg International Student Fund

Donation Type: Full Scholarship ($1000.00 +) Partial Scholarship  
Donation Amount: $  USD  

Donor Information (for tax and acknowledgement purposes)

Salutation:
Mr. Ms. Mrs. Dr.
First/Given Name:
Last/Family Name:
Organizational Affiliation:
Address:
City:
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Honoree Information (for Full Scholarship)

Designation:
In honor of:In memory of:
Name:
Dedication:

Payment Information

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Credit Card:

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Expiration Date: 010203040506070809101112 2011201220132014201520162017201820192020
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  Check: please make payable to Digital Government Society of North America and send with a copy of this form to:

Yigal Arens, Treasurer USC - ISI 4676 Admiralty Way, Suite 1001 Marina del Rey, CA 90292