New Donor OR Renewal (Circle One)
Donor Level (Check One):
___$30 - Tiger Cub Club
___$30 - IPTAY CATS
___$40
- Collegiate Club
___$130
- Collegiate Club - Tiger 4
___$500
- Sustaining Cub (Birth - 18)
___$140
-Purple Donor
___$350 - Orange Donor
___$700 - Champion Donor
___$1,400
-
Tiger
Donor
___$2,100
-
Howard
Donor
___$2,800
- IPTAY
Donor
___$5,600
-McFadden Donor
___$7,000
- Fike Donor
___$10,000
- Heisman Scholarship
Name___________________________________________________________
Mailing Address__________________________________________________
City__________________ State___________ Zip _______________________
Home Phone________________ Business/School Phone __________________
Employer________________________________________________________
E-Mail Address___________________________________________________
Your IPTAY Number ___________________________
Name of IPTAY Representative_______________________________________
Representative's IPTAY Number______________________________________
If Tiger Cub Club or IPTAY CATS:
____Infant (Birth to 5) ____Youth (6 to 12) ____Teen (13 - 17)
Birthdate_________ Given By_______________________________________
Academic Class: K - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10 - 11 - 12 (Circle One)
If IPTAY Collegiate Club:
Are you a full-time student, enrolled in at least 12 hours, at Clemson University?
Yes OR No (Circle One)
What is your class status? Grad Senior Junior Sophomore Freshman (Circle One)
Which T-Shirt size would you like? XXL - XL - L - M - S (Circle One)
Method of Payment: ___Check ___Visa ___Mastercard ____Discover
Amount Enclosed________________________________________
Credit Card Number______________________________________
Expiration Date__________________________________________
Name as it appears on card_________________________________
Signature_______________________________________________