First Name* Enter your first name using letters only.

Last Name* Enter your last name using letters only.

E-mail* Enter a valid email address.

Phone Enter a 10-digit phone number.

Address*

City*

State* Choose state Pennsylvania Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Post code* Enter a 5-digit zip code.

Company Name

Name(s) to appear in annual report of gifts*

Questions / Comments

Your LCCC Affiliation* Choose affiliation Alumnus / Alumna LCCC Faculty / Staff Corporate Sponsor Event Sponsor Friend of LCCC Patron Memorial Gift Sponsor Scholarship Sponsor Student Other

Designate My Gift To:* Choose designation LCCC Alumni Association Alumni Annual Golf Tournament Sponsor Annual Scholarship Dinner Sponsor Area of Greatest Need College Endowment Fund for Excellence Named Scholarship Peter J. Lello Food Pantry / Student Nutrition Fund Schulman Gallery Student Assistance Fund Yeager Arboretum

Amount* $