formerly University of Missouri-Rolla
Campaign for Missouri S&T
Order of the Golden Shillelagh

 

Missouri University of Science and Technology

Statement of Acceptance

 

I acknowledge the invitation to membership in

THE ORDER OF THE GOLDEN SHILLELAGH

of

The Missouri University of Science and Technology

and hereby indicate my (our) acceptance.

 

Please list my name (our names) on The Order of the Golden Shillelagh roll as:

Name(s):

In consideration of the commitments of other members of THE ORDER OF THE GOLDEN SHILLELAGH, I (we) hereby signify my (our) intention(s) to contribute to the Missouri University of Science and Technology and/or to the Miner Alumni Association for the benefit of the University:

Please select from the following options:

Option 1 - Ten Thousand dollars or more:
Contribution Amount:
Payment Rate
Junior Membership rate: $500 annually until age 30, then $2000 annually.
Student Membership rate: $100 annually while a student, $500 annually until age 30, then $2000 annually.
Payment Method

Option 2 - Twenty-five Thousand dollars or more: (must be 55 years of age or older to qualify for acceptance with a bequest or deferred gift)
Contribution Amount:
Contribution Method:

I (we) wish to designate my (our) gift as follows:
Designated for:
Unrestricted

** This statement of intention is not a legal debt to my (our) estate, and I (we) reserve the privilege to amend or revise this statement with a written notice should health or financial conditions indicate. **

Please check the following statement if it applies to you:
The University and the Miner Alumni Association have my (our) permission to use my (our) name(s) in publications, including news releases, in order to encourage others to become members.
Permission Yes. You have our permission.
No. I would rather you didn't.

Please submit the following information:
Address:
Email:
Phone:
Contact me: