Label

Fields with a ( * ) are required.

Personal Information

* First Name: Please enter a first name.

* Last Name: Please enter a last name.

* Phone Number: Please enter a 10-digit phone number.

* EMail: Please enter an e-mail address.

* Street Address: Please enter a street address.

* City: Please enter a city.

* State:

* Zip Code: Please enter a zip code.

* Country: Please enter a country.

* Relationship to student: Please enter the relationship to student.

Check if new Address

Additional Parent/Spouse/Guardian Information

First Name:

Last Name:

Phone Number:

EMail:

Check if same address as above

Street Address:

City:

State:

Zip Code:

Country:

Relationship to Student:

Student Information

* First Name: Please enter a first name.

* Last Name: Please enter a last name.

WIU ID Number:

* Date of Birth: Please enter a data of birth.

Additional Student Information

First Name:

Last Name:

WIU ID Number:

Date of Birth: (MM/DD/YYYY)

Spouse/Partner's Information

First Name:

Last Name:

Business Information

Company Name:

Job Title:

Work Phone: (XXXXXXXXXX) Please enter a 10-digit phone number.

EMail:

Work Address:

City:

State:

Zip Code:

Country:

Gift Information

* Gift Amount:

.00

Please enter a dollar amount of at least $1.

* Designation:

Academic Programs/Colleges

Sam Oliva Accountancy Challenge

Scholarships

Annual Societies and miscellaneous fundraising efforts

Unrestricted (Area of Greatest Need)

Student Services

Leatherneck Club/Athletics

Or, if designation is not listed, please specify:

Gift Amount

Gift Categories

Director .............. $2,000 & Up
Principal ............. $1,000 - $1,999
Benefactor .......... $500 - $999
Patron ................ $250 - $499
Sponsor .............. $100 - $249
Friend ................. $10 - $99

* Gift Amount:

.00

Name(s) as you would like them listed on the web and in programs:

Gift Amount

Leatherneck Club

The Leatherneck Club is an organization of alumni, friends, fans, parents, and businesses that provides annual funding for more than 400 student-athletes. These funds offer WIU student-athletes with resources they need to succeed in the classroom and compete at the NCAA Division I level.

These funds are essential to our success and assist with:

Scholarships
Capital facility projects
Athletic equipment and apparel
Specialized computer software
Travel expenses for the whole department
Broadcasting production assistance for the entire department

The greatest gift is knowing you help provide the best possible Division I experience for our Leatherneck student-athletes and enhance our sports programs. Every gift counts, every gift helps.

2023-2024 Benefits	Purple $50-$99	Gold $100-$299	Varsity $300-$599	Captain $600-$999	All-American $1,000-$2,499	VIP $2,500-$4,999	MVP $5,000-$9,999	Champion $10,000 +
Provide Support for Leatherneck Student-Athletes
Tax Deduction (a)
Web Recognition
Leatherneck Club e-newsletter
Membership Card & Decal (e)
20% Discount at WIU Bookstore (b) (e)
Advanced Ticket Purchase (c)
Access to Leatherneck Club Football Parking (with season ticket purchase) (c)
Access to Basketball Hospitality Suite (Hall of Fame Room)
Basketball Q-Lot Priority Parking (with season ticket purchase)
Football Reserved Parking (with season ticket purchase)
Basketball Lot 22 Priority Parking (with season ticket purchase)
WIU Athletics Membership Gift
Pregame Reception with WIU Director of Athletics
Coaches Dinner
Travel Opportunity to Away Game (d)

Please consult your tax professional
Receive a 20% discount on regularly-priced clothing and gifts at the WIU Bookstore
Leatherneck Club members will have the opportunity to purchase season tickets prior to the general public
Sport to be determined based on discretion of Leatherneck Club member & staff

* Gift Amount:

.00

* Designation:

Name(s) as you would like them listed on the web and in programs:

Matching Gifts

If you are affiliated with a company that matches contributions to higher education, your gift to Western may be matched, doubled, or - in some instances - more than doubled. Some companies also match gifts made by retirees and/or spouses

Company Name:

Search Matching Companies

Matching Spouse/Partner

My spouse's/partner's company will match my gift

Send your matching gift form to:

WIU Foundation
1 University Circle
Macomb, IL 61455
Fax:(309)298 - 1761
Email: WIUFoundation@wiu.edu

Membership Information

Benefits

Gold members receive all the benefits of PFA plus…

In-depth newsletters via email two to three times a semester
First release of the Union Hotel rooms for Dads' Day and Moms' Day
Scholarship opportunities
A WIU gift, which can be picked up by parent or student in the PFA office (located in the Student Development Office, University Union, First Floor). Gifts cannot be mailed.
PFA Gold Membership lasts 12 months from registration submission.

* Membership Amount:

.00

* Membership Option:

This is my first year as a Gold Member of PFA

I am renewing my membership to PFA

Please select a membership option.

Comments

WESTERN ILLINOIS UNIVERSITY - STUSERV
Sherman Hall / 1 University Circle
Macomb, IL 61455 USA
(309) 298-1414 - info@wiu.edu

Label

Gift Categories

Leatherneck Club

These funds are essential to our success and assist with:

Club Categories

Send your matching gift form to:

Benefits

Please confirm your details.

Western Illinois University

Label

Label

Gift Categories

Leatherneck Club

These funds are essential to our success and assist with:

Club Categories

Send your matching gift form to:

Benefits

Please confirm your details.