Annual Fund Contribution

Please fax or mail this form to The Actuarial Foundation. Instructions are below.

*required information

Name*
Title
Organization
Address*
City
State or Province*
Zip or Postal Code*
Phone*
E-mail*
My Annual Fund contribution is $ I would like to make monthly gifts of $ in the following months: (Please send reminders/charge my card)
Payment Type*	Check enclosed Visa MasterCard
Card Number
Name on Account
Exp. Date

Signature*	Date

I wish to designate my gift of support to one or more of the following Foundation initiatives:

Youth Programs
Consumer Education
Research
Unrestricted
Other:

Please recognize me as a Foundation Partner at the following level of support:

Visionary $25,000+
Innovator $10,000-$24,999
Pioneer $5,000-$9,999
Pathfinder $2,500-$4,999
Pacesetter $1,000-$2,400
Builder $500-$999
Advocate $250-$499
Supporter $100-$249
Contributor Under $100

I wish to designate my donation in memory/honor of

Please send an acknowledgment of my gift to:

Name*
Address*
City*
State or Province*
Zip or Postal Code*
Phone
E-mail

Please make your check payable to The Actuarial Foundation.

All Annual Fund contributions MUST be postmarked and dated by December 31st in the year gift is applied.

Please send contributions to:
The Actuarial Foundation
475 N. Martingale Rd, Suite 600
Schaumburg, IL 60173-2226

Fax: 847.706.3599
E-mail: Laura.Hogan@ActFnd.org

Thank you for your support. If you have any questions, please call The Actuarial Foundation office at 847.706.3535.