Please print the blank form. Return the completed form by fax or mail to the address below.

The Brearley Benefit 2009 Underwriters Form

Brearley Jams

Sunday, April 19, 2009 at 5:00 p.m.
Pier Sixty, Chelsea Piers
23rd Street and the Hudson River

Name(s):

Address:

City, State, Zip:

Step 1

Choose the level at which you would like to support this special effort to help build the endowment for faculty salaries at Brearley:

• $15,000
• $10,000
• $7,500
• $5,000
• $2,500

Step 2

Tell us how many tickets to reserve for you (each ticket decreases the amount of your tax deductible gift by $95 for each adult ticket and $75 for each student ticket):

• Please reserve _______ tickets for the Brearley Benefit on April 19, 2009.

Step 3

Choose the payment method you prefer:

• My check made out to The Brearley School is enclosed.
• I would like to give a gift of stock. (Please click here for stock donation instructions.)
• Charge my credit card for the amount indicated above.

• Name as it appears on card:
• Card Number:
• Expiration Date:
• Security Code:

Step 4

Help us say “Thank you” for your generous support:

• I/we prefer that my/our name(s) to be listed in the program this way:

• Name:
• (Our standard format is Mary and John Doe.)

• I/we would prefer not to be included in the list of underwriters in the program.

Step 5

Increase your gift with a match from your employer:

• My company will match the deductible portion of my gift. I’ve enclosed the form.

Step 6

Please fax this form to the Brearley Development Office at (212) 570-8630, or mail to:

• The Brearley School
  Development Office
  610 East 83rd Street
  New York, NY 10028

If you wish to be listed as an underwriter in the Benefit Program,
your form must be received by the Development Office no later than April 6.