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MEMBERSHIP FORM 2012-2013

Yes! I want to be a Groundbreaking member of the Center for Architecture and Urban Design, Los Angeles and help begin the mission of creating a center. Please accept a gift of (100% is tax-deductible): $ Name(s): Name(s) for recognition: o This is a joint gift with my spouse/partner o I/we wish to remain anonymous Company: Street Address: City: Preferred Email: Preferred Phone: State: Zip:

o Attached please find my check to: Center for Architecture and Urban Design, LA
I would like to use the following credit card: o American Express o Master Card o Visa Name (as it appears on the card): Card Number: Expiration (MM/YY): Signature: o For my convenience, I would like my gift to be paid in installments* and please automatically deduct my pledge payments in accordance with the payment schedule selected below from my credit card as provided. I would like the following payment schedule (select one): o 2 semi-annual payments: January 31 and July 31 o 4 quarterly payments: January 31, April 30, July 31 and October 31 Please charge my first payment on (closest corresponding date from above): o My company will match my donation. Attached is my matching gift form.
Email to: rob@laarchcenter.org or Fax to: 213.639.0767 or Mail to: Center for Architecture and Urban Design 3780 Wilshire Blvd Suite 800 Los Angeles, CA 90010 For more information about CALA Membership please call Rob Hollman: 213.404.0105 The Center for Architecture and Urban Design, Los Angeles is a registered 501c(3) non-profit organization Privacy Notice: All furnished information is strictly voluntary and will be maintained confidentially

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*Automatic Payment Plan Agreement: I hereby authorize the Center for Architecture and Urban Design, Los Angeles (Tax I.D # 27-5385832) to initiate debit entries according to my payment plan for my remaining payments and (credit) adjustments for any debit entries in error to my designed credit card account. This authority is to remain in effect until the balance has been fulfilled or until the Bank receives written notification from me of its termination in such time and in such manner to afford the Bank reasonable opportunity to act.