Sigma Xi Contribution Form

I would like to donate to Sigma Xi

I would like to donate to the Sigma Xi Fund of Canada

Sigma Xi Contribution Form

Sigma Xi Fund of Canada Contribution Form

Donor Information

Are you a member of Sigma Xi?

Yes, I am a Sigma Xi member.

No, I am not a Sigma Xi member.

Member ID:

Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Address Line 1:

Address Line 2:

Address Line 3:

City: State/Prov.:

Zip/Postal Code: (note: type none if foreign address)

Country:

Primary Telephone: (format: 123-456-7890)

Home Telephone: (format: 123-456-7890)

Business Telephone: (format: 123-456-7890)

Fax: (format: 123-456-7890)

E-Mail:

The Sigma Xi Fund of Canada to Benefit:

Grants-in-Aid of Research Canada:	CAD$
Canadian Chapter Activities Fund:	CAD$

The Sigma Xi Fund (annual campaign):	$
Grants-in-Aid of Research:	$

CAD$

USD$

Payment

By filling out the following information, you are authorizing Sigma Xi to charge your account with the amount(s) specified above.

Credit Card Type: Visa MasterCard American Express Discover
Credit Card Number (do not enter spaces or dashes):
Expiration Date: Month Year: 3 or 4 digit security code:

Once you have completed the above information, please review it carefully before clicking the "Submit" button below. After submitting, a confirmation form will be generated for your records.

Sigma Xi Fund of Canada BN/Registration Number: 119149813RR0001

This form is located on a secure server. Any information you provide will be kept ONLY in a secured location and is encrypted upon submission. To protect your personal information, we will not include your credit card information on your member record. Privacy Information.

Sigma Xi, The Scientific Research Society
3106 East NC Highway 54
P.O. Box 13982
Research Triangle Park, NC 27709
Telephone: 800-243-6534 or 919-549-4691
E-mail: finance@sigmaxi.org

Sigma Xi is a 501(c)(3) not-for-profit. All donations made are tax-deductible in the U.S.

EIN available upon request