___ Patron's ($1,000-4,999) ___ Benefactors ($5,000-9,999) ___ Legacy ($10,000 plus)

My Gift/Pledge (circle one) $__________
I would like to remain anonymous____
Name: __________________________________________________________________
(Please print family, business name as you would like it to read in all donor recognitions)

My employer will match my gift: ____________________________________________
(Company Name)

Pledge to be paid by (specific date) ____/____/2010 Please invoice me____
I'd like to do multiple installments: _________________ to begin on: ____/____ /2010
(Please specify terms)

Charge my: __Visa __MC __AMEX C.C. #__________________________ Exp.___/___
Signature: ____________________________________________ Date:____________

All contributions are tax deductible and gratefully received.

Mailing Address: _______________________________________________________
City: ________________________________________ Zip _____________________
Phone:____________________E-Mail:______________________________________

Circle your affiliation to Hillcrest Academy: Parent/Faculty/Trustee/ Friend/
Alumna Class of ____ /Grandparent/Other: __________________________________
Please send me information about planned giving opportunities____ (check here)
______________________________________________________________________