Donations and Gifts

Please complete this form and return it and your gift to:

Friends of Environmental Toxicology, Department of Environmental Toxicology, University of California,One Shields Avenue, Davis, CA 95616-8588, (530) 752-2732, fet@ucdavis.edu

Yes, I/we would like to help the UC Davis Department of Environmental Toxicology with a tax-deductible gift of:

$1,000 $500 $250 $100 $50 Other: $ _________

Please credit this donation in the name(s) of:

Apply to:

Unrestricted (use as needed)

Undergraduate Scholarships

Graduate Student Fellowships/Scholarships

Faculty/Student Research

Extracurricular Student Activities

Extension Scholarship

Fund in memory of :

Other :

Amount enclosed $ __________

Please make checks payable to the UC Regents

Corporate Matching Gift form enclosed? Check your personnel office for details.

Please provide the following information:

First name:

Last name:

Class year (if applicable):

Maiden name (if applicable):

Home phone:

Home address:

Employer name:

Word address:

Your title:

Work phone:

Email address:

Web page address:

Preferred mailing address: Home Business

Thank you for your support!