Name __________________________________________________________________
Address ________________________________________________________________
City___________________________________State________ Zip_________________
Daytime Phone_____________________ Evening Phone _________________________
Fax__________________E-mail Address______________________________________
My tax-deductible contribution is enclosed to help create a living legacy for the International Piano Archives at Maryland.
q Enclosed is a check in the amount of $___________ payable to the University System of Maryland Foundation, indicating “Neil Ratliff Fund” on the memo line.
q Please charge $______________to my credit card:
____Master Card ____VISA ____American Express
Account Name_____________________________________________________
Card Number ___________________________________ Exp. Date__________
Signature _________________________________________________________
q I would like to request a seat.
Please contact me about my naming opportunity.
q Name(s) designated to appear on the chair (please print):
_______________________________________________________________
Please contact me to discuss my giving options to the Neil Ratliff Fund.
Please send completed form and payment to: