02 TAME, Inc. 30 Amarillo 28 BCAME 10 Capital Area 12 DAME 46 ETAME 22 FAME (Ft. Worth) 18 Four Corners 20 GCAME (Golden Crescent/Victoria) 06 GCTAME (Gulf Coast) 16 GTTAME 24 Lubbock 26 Midland 36 Odessa 04 Rio Grande Valley 08 SAAME 42 Waco 32 Wichita Falls CHOOSE THE ALLIANCE ACCOUNT TO WHICH THIS DEPOSIT SHOULD BE APPLIED

AMOUNT OF DEPOSIT:           CHECK NUMBER:

FROM:     (TAME, INC WILL SEND ACKNOWLEDGEMENT OF DONATION RECEIPT TO THE PERSON AND ADDRESS YOU PROVIDE BELOW.)

NAME no title Mr. Mrs. Ms. Dr.

COMPANY

MAILING ADDRESS

CITY, STATE, ZIP

TELEPHONE NUMBER

DEPOSIT TO: Scholarship Funds Program Funds Unrestricted Funds

If program use, please specify program:

SUBMITTED BY (please print name):

SIGNATURE: _________________________________________________   DATE:

NOTE:   ATTACH CHECK (PLEASE DO NOT STAPLE CHECK) 

AND LETTER FROM DONOR SPECIFYING THE PURPOSE AND USE OF FUNDS.

MAIL TO: TAME, INC. / UT-AUSTIN, R9200 / 10100 BURNET ROAD / BLDG. 16, ROOM 10 / AUSTIN, TX  78758

FOR STATE OFFICE USE:                CHECK AMOUNT/DEPOSIT AMOUNT: _____________ /______________

                                                        TYPE OF CONTR: ______________ DATE DEPOSITED: ______________