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Background Information
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Last Name:
Street Address:
City:
State:
Postal Code:
Country:
Afghanistan
Albania
Algeria
Andorra
Angola
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Argentina
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Aruba
Australia
Austria
Azerbaijan
Bahrain
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Belgium
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Belorussia
Benin
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Bhutan
Bolivia
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Botswana
Brazil
British Virgin Islnd
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
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Denmark
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Estonia
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Finland
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Gabon
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Germany
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Greenland
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Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
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Hungary
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India
Indonesia
Iran
Iraq
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Israel
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Jamaica
Japan
Jordan
Kampuchea
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Kenya
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Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Mali
Malta
Martinique
Mauritania
Mauritius
Mexico
Moldova
Monaco
Mongolia
Montserrat Island
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norway
Oman
Pakistan
Panama
Papua New Guinea
Paraguay
People's Rp of China
Peru
Philippines
Pitcairn
Poland
Portugal
Qatar
Republic of Korea
Republic of Maldives
Reunion Islands
Romania
Russia
Rwanda
Saint Lucia
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
The Bahamas
The Gambia
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islnd
Tuvalu
USA
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Yugoslavia
Zambia
Zimbabwe
E-mail:
Phone:
Home:
Business
Spouse Information:
First:
Middle:
Last:
Maiden:
Ball State University Affiliation:
Alumnus/Alumna
Faculty/Staff
Friend
Parent
Attended
Other
Class Year:
Gift Information:
Amount
$
Allocation:
The Ball State Fund (University's Greatest Need)
Indiana Academy
Ball State Stadium Campaign
College of Applied Science and Technology
College of Architecture and Planning
Miller College of Business
College of Communication, Information and Media
College of Fine Arts
College of Sciences and Humanities
Teachers College
Honors College
Graduate School
Cardinal Varsity Club
Indiana Public Radio
University Libraries - Tribute with Books
WIPB - Public Television for East Central Indiana
Other
If allocation is Other, please specify:
Credit Card Information
Name as it appears on credit card:
Credit Card:
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MasterCard
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Discover
American Express
Card Number:
Expiration Date:
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February
March
April
May
June
July
August
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October
November
December
Year:
select
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
Credit Card Billing Address
(if different from above)
Street:
City:
State:
Postal Code:
Country:
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Barbados
Belgium
Belize
Belorussia
Benin
Bermuda
Bhutan
Bolivia
Bosnia-Herzegovina
Botswana
Brazil
British Virgin Islnd
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Rep
Chad
Chile
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dm People's Rp Korea
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
England
Equatorial Guinea
Estonia
Ethiopia
Faroe Islands
Falkland Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadaloupe
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kampuchea
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Mali
Malta
Martinique
Mauritania
Mauritius
Mexico
Moldova
Monaco
Mongolia
Montserrat Island
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norway
Oman
Pakistan
Panama
Papua New Guinea
Paraguay
People's Rp of China
Peru
Philippines
Pitcairn
Poland
Portugal
Qatar
Republic of Korea
Republic of Maldives
Reunion Islands
Romania
Russia
Rwanda
Saint Lucia
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
The Bahamas
The Gambia
Togo
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islnd
Tuvalu
USA
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Yemen
Yugoslavia
Zambia
Zimbabwe
Employment Information:
Many employers will match your gift. The match can double and sometimes triple the size of your gift in support of Ball State University:
Employer:
Job Title:
Spouse's Employer:
Job Title:
You can double or triple your gift to Ball State if you or your spouse is employed by one of the more than one thousand companies that match employees' charitable gifts. Check with your human resources office and send the matching gift form to:
Ball State University Foundation
PO Box 672
Muncie, IN 47308
Comments:
Office of University Development
Ball State University
Muncie, Indiana 47306
Email:
Giving@bsu.edu
(765) 285-8261,
telephone
(765) 285-1218,
facsimile
Ball State University Foundation
PO Box 672
Muncie, IN 47308
(765) 285-8312
(765) 285-7060
Copyright
© 2003.
Ball State University.
Muncie, IN 47306.
All rights reserved.
Equal Opportunity and
Affirmative Action
.