Fundacion Universidad de Golfito / Universidad del Pacífico Sur

Cheque Donation Form

Thank you for your interest in supporting the Universidad del Pacifico Sur through the "Fundacion Universidad de Golfito."
This form allows you to support the Universidad del Pacifico Sur efforts for conservation, research and quality higher
education for underprilidged youth in Southern Costa Rica.

Please make your donation payable to "Fundación Universidad de Golfito"
Donations can be in Costa Rican colones, U.S. dollars, or in Euros.
If you prefer to make a direct wire transfer directly to our bank account at Banco Nacional, Golfito, please use the Wire Transfer Form.
Otherwise, please print this form and fill it out with your information.
Insert this page together with your cheque in an envelope and post it to the following address:

Fundacion Universidad de Golfito (ProSur)

Km23 Ruta 14, Golfito 60701
Costa Rica.

Thank you again for your support.

Name ______________________________________________________________________________

Address ____________________________________________________________________________

City _____________________________________ State ______________ Zip ___________________

Phone __________________________________ E-mail _____________________________________

Amount donated: _____________________________

Please direct my contributions to:        Forest Conservation Fund ____________________

                                                                    Scholarship Fund __________________________

                                                                    Research Fund ___________________________

                                                                    Faculty Fund    ____________________________

Signature ________________________________________________ Date _____________________

Universidad de Golfito (ProSur) Foundation

Cheque Donation