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Shalek Fellowship Donor/Pledge Card

Donation/Pledge Card

Robert J. Shalek Fellowships in Medical Physics

2011-2013 Campaign

 

Name                                                                   

Title                                                 

Address                                                                                  

                                                                                             

 

 

Total Donation/Pledge:  (all contributions are fully tax deductible)

 $100          $200          $500          $1,000       $                       

 

 Payment Enclosed:                                                  

 

 Amount Pledged:                                    by                             

 

Please apply this contribution to (circle one):

  • M.S. in Medical Physics Program

  • Ph.D. Program in Medical Physics

  • Either

 

Do your (or your spouse’s) institution/company have a matching gift program?

              Yes             No

Check should be made payable to:  Robert J. Shalek Fellowship Fund

 

Mail all donations/pledges to:

Shalek Fellowships
Attn:  Georgeanne R. Moore
Dept. of Imaging Physics – Unit 1472
The University of Texas MD Anderson Cancer Center
1400 Pressler Street
Houston, TX  77030

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© 2012 The University of Texas MD Anderson Cancer Center