Please maximize this window then print this form and mail to:	640 Bay Road Queensbury, NY 12804 518-743-2243
	Adirondack Community College Foundation, Inc.
*Name ______________________________________________________________________________________________________
*As you wish it to appear in the Foundation's next Annual Report
Street _________________________________________  Phone ____________________________________
City ___________________________  State ______  Zip ________   E-mail address _________________________________
Are you an ACC graduate? ______   Graduation date ___________   Your name at graduation _________________________
(if different from above)
Director's Circle $5,000+ President's Circle  $2,500 - 4,999 Leadership Circle $1,000 - 2,499 Benefactor $500 - 999 Sponsor $250 - 499 Supporter $100 - 249 Friend $50 - 99 Donor $1 - 49   Enclosed is my gift of: $______________________________ Method of payment:  Check      VISA      MasterCard Card #________________________________ Exp. date_______________ Signature_____________________________________________________ Please make check payable to the Adirondack Community College Foundation, Inc. My gift will be matched by _______________________________________________________________________________________      Form is enclosed.                    Employer has been notified.