Thank you for choosing to support the Alpha Xi Delta Foundation. You are helping inspire young women to realize their potential in leadership, knowledge and service.

MY INFORMATION
First Name

Last Name

Maiden Name

Address

City

State

AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip

Country

Preferred phone number

Home
Work
Mobile
Phone number

Email

My Alpha Xi Delta Initiating Chapter (if applicable)

Alpha
Alpha Alpha
Alpha Beta
Alpha Chi
Alpha Delta
Alpha Deuteron
Alpha Epsilon
Alpha Eta
Alpha Gamma
Alpha Iota
Alpha Kappa
Alpha Lambda
Alpha Mu
Alpha Nu
Alpha Omega
Alpha Omicron
Alpha Phi
Alpha Pi
Alpha Psi
Alpha Rho
Alpha Sigma
Alpha Tau
Alpha Theta
Alpha Upsilon
Alpha Xi
Alpha Zeta
Beta
Beta Alpha
Beta Beta
Beta Chi
Beta Delta
Beta Epsilon
Beta Eta
Beta Gamma
Beta Iota
Beta Kappa
Beta Lambda
Beta Mu
Beta Nu
Beta Omega
Beta Omicron
Beta Phi
Beta Pi
Beta Psi
Beta Rho
Beta Sigma
Beta Tau
Beta Theta
Beta Upsilon
Beta Xi
Beta Zeta
Chi
Colony: WPI
Delta
Delta Alpha
Delta Beta
Delta Chi
Delta Delta
Delta Epsilon
Delta Eta
Delta Gamma
Delta Iota
Delta Kappa
Delta Lambda
Delta Mu
Delta Nu
Delta Omega
Delta Omicron
Delta Phi
Delta Pi
Delta Psi
Delta Rho
Delta Sigma
Delta Tau
Delta Theta
Delta Upsilon
Delta Xi
Delta Zeta
Epsilon
Epsilon Alpha
Epsilon Beta
Epsilon Chi
Epsilon Delta
Epsilon Epsilon
Epsilon Eta
Epsilon Gamma
Epsilon Iota
Epsilon Kappa
Epsilon Lambda
Epsilon Mu
Epsilon Nu
Epsilon Omega
Epsilon Omicron
Epsilon Phi
Epsilon Pi
Epsilon Psi
Epsilon Rho
Epsilon Sigma
Epsilon Tau
Epsilon Theta
Epsilon Upsilon
Epsilon Xi
Epsilon Zeta
Eta
Gamma
Gamma Alpha
Gamma Beta
Gamma Chi
Gamma Delta
Gamma Epsilon
Gamma Eta
Gamma Gamma
Gamma Iota
Gamma Kappa
Gamma Lambda
Gamma Mu
Gamma Nu
Gamma Omega
Gamma Omicron
Gamma Phi
Gamma Pi
Gamma Psi
Gamma Rho
Gamma Sigma
Gamma Tau
Gamma Theta
Gamma Upsilon
Gamma Xi
Gamma Zeta
Iota
Iota Alpha
Iota Beta
Iota Delta
Iota Epsilon
Iota Eta
Iota Gamma
Iota Iota
Iota Kappa
Iota Lambda
Iota Mu
Iota Nu
Iota Theta
Iota Xi
Iota Zeta
Iota Omicron
Iota Pi
Iota Rho
Iota Sigma
Iota Tau
Iota Upsilon
Iota Phi
Iota Chi
Iota Psi
Iota Omega
Kappa
Lambda
Mu
Nu
Omega
Omicron
Phi
Pi
Psi
Rho
Sigma
Tau
Theta
Theta Alpha
Theta Beta
Theta Chi
Theta Delta
Theta Epsilon
Theta Eta
Theta Gamma
Theta Iota
Theta Kappa
Theta Lambda
Theta Mu
Theta Nu
Theta Omega
Theta Omicron
Theta Phi
Theta Pi
Theta Psi
Theta Rho
Theta Sigma
Theta Tau
Theta Theta
Theta Upsilon
Theta Xi
Theta Zeta
Upsilon
Xi
Zeta
Zeta Alpha
Zeta Beta
Zeta Chi
Zeta Delta
Zeta Epsilon
Zeta Eta
Zeta Gamma
Zeta Iota
Zeta Kappa
Zeta Lambda
Zeta Mu
Zeta Nu
Zeta Omega
Zeta Omicron
Zeta Phi
Zeta Pi
Zeta Psi
Zeta Rho
Zeta Sigma
Zeta Tau
Zeta Theta
Zeta Upsilon
Zeta Xi
Zeta Zeta
or
Friend of Alpha Xi Delta

Yes

GIFT INFORMATION

Please enter the amount you would like to give rounded to the nearest dollar. DO NOT use dollar signs ($) or leave spaces to the left of your amount.

Donation Amount

My gift is

in honor of
in memory of
Name of person gift honors or remembers

Her Alpha Xi Delta Initiating Chapter (if applicable):

Alpha
Alpha Alpha
Alpha Beta
Alpha Chi
Alpha Delta
Alpha Deuteron
Alpha Epsilon
Alpha Eta
Alpha Gamma
Alpha Iota
Alpha Kappa
Alpha Lambda
Alpha Mu
Alpha Nu
Alpha Omega
Alpha Omicron
Alpha Phi
Alpha Pi
Alpha Psi
Alpha Rho
Alpha Sigma
Alpha Tau
Alpha Theta
Alpha Upsilon
Alpha Xi
Alpha Zeta
Beta
Beta Alpha
Beta Beta
Beta Chi
Beta Delta
Beta Epsilon
Beta Eta
Beta Gamma
Beta Iota
Beta Kappa
Beta Lambda
Beta Mu
Beta Nu
Beta Omega
Beta Omicron
Beta Phi
Beta Pi
Beta Psi
Beta Rho
Beta Sigma
Beta Tau
Beta Theta
Beta Upsilon
Beta Xi
Beta Zeta
Chi
Colony: WPI
Delta
Delta Alpha
Delta Beta
Delta Chi
Delta Delta
Delta Epsilon
Delta Eta
Delta Gamma
Delta Iota
Delta Kappa
Delta Lambda
Delta Mu
Delta Nu
Delta Omega
Delta Omicron
Delta Phi
Delta Pi
Delta Psi
Delta Rho
Delta Sigma
Delta Tau
Delta Theta
Delta Upsilon
Delta Xi
Delta Zeta
Epsilon
Epsilon Alpha
Epsilon Beta
Epsilon Chi
Epsilon Delta
Epsilon Epsilon
Epsilon Eta
Epsilon Gamma
Epsilon Iota
Epsilon Kappa
Epsilon Lambda
Epsilon Mu
Epsilon Nu
Epsilon Omega
Epsilon Omicron
Epsilon Phi
Epsilon Pi
Epsilon Psi
Epsilon Rho
Epsilon Sigma
Epsilon Tau
Epsilon Theta
Epsilon Upsilon
Epsilon Xi
Epsilon Zeta
Eta
Gamma
Gamma Alpha
Gamma Beta
Gamma Chi
Gamma Delta
Gamma Epsilon
Gamma Eta
Gamma Gamma
Gamma Iota
Gamma Kappa
Gamma Lambda
Gamma Mu
Gamma Nu
Gamma Omega
Gamma Omicron
Gamma Phi
Gamma Pi
Gamma Psi
Gamma Rho
Gamma Sigma
Gamma Tau
Gamma Theta
Gamma Upsilon
Gamma Xi
Gamma Zeta
Iota
Iota Alpha
Iota Beta
Iota Delta
Iota Epsilon
Iota Eta
Iota Gamma
Iota Iota
Iota Kappa
Iota Lambda
Iota Mu
Iota Nu
Iota Theta
Iota Xi
Iota Zeta
Iota Omicron
Iota Pi
Iota Rho
Iota Sigma
Iota Tau
Iota Upsilon
Iota Phi
Iota Chi
Iota Psi
Iota Omega
Kappa
Lambda
Mu
Nu
Omega
Omicron
Phi
Pi
Psi
Rho
Sigma
Tau
Theta
Theta Alpha
Theta Beta
Theta Chi
Theta Delta
Theta Epsilon
Theta Eta
Theta Gamma
Theta Iota
Theta Kappa
Theta Lambda
Theta Mu
Theta Nu
Theta Omega
Theta Omicron
Theta Phi
Theta Pi
Theta Psi
Theta Rho
Theta Sigma
Theta Tau
Theta Theta
Theta Upsilon
Theta Xi
Theta Zeta
Upsilon
Xi
Zeta
Zeta Alpha
Zeta Beta
Zeta Chi
Zeta Delta
Zeta Epsilon
Zeta Eta
Zeta Gamma
Zeta Iota
Zeta Kappa
Zeta Lambda
Zeta Mu
Zeta Nu
Zeta Omega
Zeta Omicron
Zeta Phi
Zeta Pi
Zeta Psi
Zeta Rho
Zeta Sigma
Zeta Tau
Zeta Theta
Zeta Upsilon
Zeta Xi
Zeta Zeta
Please send notice of my gift to

Address

City

State

AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip

Special comments or instructions

If you are interested in designating your gift to a specific fund or program, please make a note in the “special comments or instructions” box above or email foundation@alphaxidelta.org .

MY PAYMENT INFORMATION

Type of Credit Card

Visa
Mastercard
Discover
American Express
Credit Card Number

CVV Number (the last three or four digit number on the back of the card in the signature bar)

Expiration Date

01
02
03
04
05
06
07
08
09
10
11
12
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
Name as it appears on the card

Billing Address

City

State

AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code

Your gift is tax deductible as allowed by law because Alpha Xi Delta Foundation is a 501 (c) (3) public charity.