I would like to make a commitment of:

	Four-week Sponsorship	$2,750
	Two-week Sponsorship	$1,240
	One-week Sponsorship	$610
	$100

	Other _____________________________________________________________
	In-kind contributions _________________________________________________
	In honor of_________________________________________________________
	In memory of_______________________________________________________

Name ________________________________________________________________

Address ______________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Village (staff only)_______________________________________________________

Payment Options:

	check attached
	bill me (starting date and number of payments)
	__________________________________________
	gift will be matched by________________________
	payroll deduction: $__________/for _______months
	Social Security Number_______________________
	credit card

Visa

Master Card

American Express

Acct. # ______________________________________ Exp. Date _______________

Signature and Date _____________________________________________________

Please make your check payable to Concordia Language Villages Passport Fund and send it with this form to:

Concordia Language Villages Concordia College 901 8th St S Moorhead, MN 56562

Your gift is tax deductible as defined by law. I/We understand that this pledge does not represent a binding obligation on my/our or on the part of my/out heirs.