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Donation Form
Leave Your Mark when you Take a Seat and Pave the Way
******If you would like to make your payment in installments, please be in touch with Kendall Nelson at kendallnelson@miami.edu or (305) 284-4614. Your seat plaque(s) and/or paver(s) will not be installed until payment is received in full.******
Amount:
Yes! I would like to Take a Seat
$5,000.00
Yes! I would like to Pave the Way
$1,000.00
$
*
Take a Seat
*Note: Text for the Seat can fit up to 3 lines of text at 18 characters per line. Text for the Paver can fit up to 4 lines of text at 27 characters per line.
Frequency:
Weekly
Monthly
Quarterly
Annually
Every 4 weeks
On:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Starting:
Ending:
Ending:
Engraving Text:
Billing Information
Title:
Dr.
M.
Miss
Mr.
Mrs.
Ms.
*
First name:
*
Last name:
*
Country:
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Cambodia
Cameroon
Canada
Canary Islands
Cayman Islands
Central African Republic
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Costa Rica
Côte d'lvoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
England
Estonia
Eswatini
Ethiopia
Faroe Islands
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guadeloupe
Guatemala
Guernsey
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea (Democratic People's Republic of)
Korea, Republic of
Kosovo
Kuwait
Kyrgyz Republic
Lao People's Democratic Republic
Latvia
Lebanon
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malaysia
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia (Federated States of)
Moldova, Republic of
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nepal
Netherlands
Netherlands Antilles
New Zealand
Nicaragua
Niger
Nigeria
Niue
North Macedonia
Northern Ireland
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Qatar
Redonda
Republic of Mali
Romania
Russian Federation
Rwanda
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Vincent and the Grenadines
San Marino
Saudi Arabia
Scotland
Senegal
Serbia
Singapore
Sint Maarten (Dutch)
Slovakia
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turks and Caicos Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United Kingdom of Great Britain and Northern Ireland
United States
Uruguay
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Vanuatu
Vatican City
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Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wales
Windward Islands
Yemen
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Zimbabwe
*
Address:
*
City:
*
State:
<Please Select>
AA
AE
AK
AL
AP
AR
AS
AZ
CA
CO
CT
CZ
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
ZIP:
*
Phone:
Email:
*