Thank you. By naming a chair, you are helping the Fielding School create healthy futures for all: locally, nationally and globally.



Required fields are indicated with an asterisk (*).
Sponsorship Levels (100% tax-deductible)
SelectDescriptionAmount
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: 

Personal
Title:
 
* First name:  
  Middle name:
* Last name:  
  Suffix:
  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 telephone:    
Business telephone:  

* E-mail address:  
* This e-mail is my:  

Matching Gift

  My/my spouse's employer will match my gift.
  Company name for matching gifts:
  This company is:
Payment method:
I am the parent of a current UCLA student
  Student name:
  Anticipated graduation year:
This gift is anonymous
 
Comments: