First Name Last Name Middle Initial Address City State Zip Code E-Mail Address Football Men's Basketball Line 1 YES, I would like to receive priority points for my gift (select sport) NO, I do not wish to receive priority points for my gift Gifts are 100% tax deductible Personal Information Payment Information Check Credit Card Credit Card # Month Year Payment Method: Expiration Date: Amount to charge today $ Bollard Information Phone Number Line 2 Line 3 Please return information to: Gator Boosters, Inc. Attn: Gator Bollard Project P.O. Box 13796 Gainesville, FL 32604 (352) 375-4683 x5000 Each line is limited to 20 characters (including spaces and special characters) Gator Bollard Project Membership Name Letters are 5/8" tall Bollard Number 1 year, $10,000 2 years, $5,000 Please make checks payable to Gator Boosters, Inc. Due to changes in tax law, if points are taken gifts are not tax deductible Please sign: ______________________________________________