IPTAY On-line Donations

IPTAY On-line Donations New Member (or) Renewal, please provide Donor No.

Donor Information

First name:	MI:
Last name:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (D.C.) Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Home Phone:
Business/School Phone:
Email Address:
Date of birth:	– (ex. mm/dd/yyyy)
Social Security Number:
Employer (if applicable):
Name of IPTAY representative:
Representatives IPTAY Number:

Donor Program – please select the program(s) you would to join. Please note some programs will ask for additional information.

Sustaining Membership ($500 minimum) – for ages birth to 22 Please fill in information below that is appropriate according to age

- Academic Class: (ex. 8th Grade)
- T-Shirt Size:
- Personalized Brick ($250 Minimum)
- Location of Brick
  - Football
  - Baseball
  - Basketball
  - Howard’s Rock (Lettermen Only)
- Please enter your name (only one per brick) as you wish to appear on brick:
Tiger Cub Club ($30 Minimum) – for ages infant-to-12
- Category
  - Infant (birth to 5)
  - Youth (6-12)
IPTAY CATS ($30 Minimum) – for ages 13 – 17 Collegiate Club ($30 Minimum) Collegiate Club – $500 sustaining member
- Current full-time student (12+ hours at CU) – Yes No
- If new member, inidcate T-shirt size – XXL XL L M
- If renewing member, IPTAY Hat or T-shirt (if T-shirt, indicate size above)
- Class status:
  - Graduate
  - Senior
  - Junior
  - Sophomore
  - Freshman
100 Gold Card Donor ($100 Minimum) 250 Gold Card Donor ($250 Minimum) 500 Gold Card Donor ($500 Minimum) Tiger Scholarship Donor ($1,000 Minimum) IPTAY Scholarship Donor ($2,000 Minimum) Fike Scholarship Donor ($5,000 Minimum) Tiger Pride Campaign Donor

By making donation to Clemson University I certify that I will follow and abide by all NCAA regulations. Failure to do so will result in immediate loss of IPTAY priorities.

Donor Payment Amount: $(Fill in associated amount for your donor program) Credit Card Number: Credit Card Expiration Date: Credit Card Type: