Full Court Support 2005-2006

Thank you for your support of Indiana University Southeast Men's Basketball. Please complete this form and return to:

Indiana University Southeast Men's Basketball
c/o Joe Campbell
4201 Grant Line Road, New Albany, IN 47150-6405

Please provide the following contact information:

Name

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Home Phone

E-mail

T-Shirt Size L     XL     XXL

# of Additional Shirts($15 a piece)

Size of Additional Shirts

I would like to donate: $100     $75     $50
$25    Other$___

I will pay by:
Make Check payable to Indiana University Foundation/IUS (Donation is tax deductible)
Credit Card     Check

Please Charge my: Visa      MasterCard
Exp. date
Card Number

Signature____________________

Name
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
E-mail
T-Shirt Size	L XL XXL
# of Additional Shirts($15 a piece)
Size of Additional Shirts
I would like to donate:	$100 $75 $50 $25 Other$___
I will pay by: Make Check payable to Indiana University Foundation/IUS (Donation is tax deductible)	Credit Card Check
Please Charge my:	Visa MasterCard Exp. date Card Number Signature____________________