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2. Donation or Sponsorship Information (please complete)

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Emplid: Campaign: Appeal: Designation: Program:

Charity: UWO UWO Fdn. Inc. UK Fdn. HK Fdn.

Advancement Services260 Westminster HallPhone: 519-661-4176Fax: 519-661-4182

Charitable Number#10816 2587 RR0001

Questions? Please contact Janice Van Der Klugt atjburchil@uwo.ca or 519-661-2111 x85321

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Fund Type: Gift Agreement: Yes No

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