IPTAY Donor Application

IPTAY Application

Please print the application below, fill in all information, and mail to: IPTAY , PO Box 1529, Clemson, SC 29633. Make all checks payable to ” IPTAY “.

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) ___$160 -Purple Donor ___$400 – Orange Donor ___$800 – Champion Donor ___$1,600 – Tiger Donor___$2,400 – Howard Donor ___$3,200 – IPTAY Donor ___$4,600 – Jervey Donor ___$6,000 – McFadden Donor ___$7,500 – Fike Donor ___$10,500 – Heisman Donor

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_______________________________________________