Name *
Street Address *
City, State, Zip *
Telephone Number *
E-Mail Address*
Donation Amount: *
Gift Type	My own gift In honor of In memory of
Name in honor or memory of
Name and Address for notice of gifts in honor/memory
How would you like your name to appear on our donor appreciation listings?
Payment Method *	Check enclosed Charge WAC Member account Securities will be transferred to Foundation account Z69480193 at Fidelity
Authorized Signature *
Date *
You may submit this form by clicking on the Submit button below, or by faxing it to the Controller at the Woman's Athletic Club, to 312-944-6546. You will receive a charitable donation acknowledgement for your tax deduction records in the mail. Thank you in advance for your generosity.
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