Alumni Matching Challenge Donation Form

Thank you! Your gift will have double the impact. All gifts made towards graduate student support and/or the Active Living Centre will be matched dollar for dollar by the Alumni Association of the University of Manitoba. Together, we can support our graduate students and provide a state-of-the-art health, wellness, research and fitness centre for our community.

Required fields are marked with an asterisk (*).

*I want to direct my gift to...
Active Living Centre
Alumni Association Graduate Student Fellowship
OR
I'd like to support graduate fellowships in:
OR
I'd like to support a specific graduate student fellowship:
Payment Options:
Visa Master Card American Express Pre-authorized Payment Cheque
Payroll deduction (Staff only)
Installment Amount:
$

* I am giving as a:
Graduate UofM Parent Faculty/Staff Student Friend

Graduate Information
Last U of M Faculty or School attended:

Last Degree:
(i.e. B.A., M.Sc.)

Graduation Year:

Faculty & Staff
Student Information
U of M Faculty or School:
Contact Information
Your contact information assists the university in ensuring your alumni records are up to date and allows us to get in touch with you if necessary.
* First Name:

Middle Name:

* Last Name:

Last Name at birth:
(if different from above)

* Address:

* City:

* Country:

*Zip/Postal Code:

* E-Mail Address:

* Telephone:
() -

This gift should also be in the name of my spouse.
I am considering a bequest for the University and would like more information
I wish to remain anonymous.
For recognition purposes, I wish to be recognized as .
I want to make this gift in honour of in memory of

Your credit card information will be kept private and is submitted via a secure connection.

Thank you for helping us double the potential!