UCLA Giving

Gift Information

Sponsorship Levels (100% tax-deductible)
Select	Description	Amount

	FRONT ROW - $5,000 EACH CHAIR Only nine available. Act fast to secure your front-row seat!
	ROWS 2 to 4 - $2,500 EACH CHAIR Limited Number Available
	ROWS 5 to 10 - $1,000 EACH CHAIR

Sub-Total:
Tax-Deductible:

Additional Gift

I/We are unable to sponsor a chair naming at this time, but would like to make a tax-deductible donation to the Fielding School.

I would like to make a fully tax-deductible gift of * Other $ *

Grand Total:

Tax-Deductible:

Nameplate Dedication

In the field below, please provide us the name and dedication you wish to appear on the name plate.

Examples:

Joe Bruin, MPH ’15
In Honor of Prof. Josephine Bruin

Jody Bruin
Class of 1972

Jerry Bruin
In Memory of Josie Bruin, PhD ’66

Please limit each of the two lines to thirty characters.

* Dedication text:

Donor Information

Personal

Title:

First name:

Middle name:

Last name:

Suffix:

I am making this gift as a proxy for my organization/company, which should be recognized as the legal donor

Birth date (mm/dd/yyyy):

UCLA graduation year(s):

Spouse/Partner

Name:

UCLA graduation year(s):

Joint Gift

This is a joint gift with
my spouse/partner:

Contact Information

Street:

U.S. Addresses

City, State, Zip:

Non-U.S. Addresses

Non-U.S. City/County
or Province/Postal Code:

Country:

This address is my:

Home

Business

Home telephone:

Invalid phone number *

Business telephone:

Invalid phone number

E-mail address:

This e-mail is my:

Home

Business

Gift Options

Matching Gift

Click here to find out if your company will match your gift.

My/my spouse's employer will match my gift.

Company name for matching gifts:

This company is:

My employer

My spouse's employer