U.S. PLEDGE FORM FOR LEMUEL HENRY SCHOLARSHIP FUND
I wish to pledge my financial support to the Lemuel Henry scholarship. Payable in the amount of:
- -- US $ 20
- -- US $ 50
- -- US $ 100
- -- US $ 500
- -- Other: ----------------------------------------------------------------------------------
Name: ---------------------------------------------------------------------------------------------
Address: -----------------------------------------------------------------------------------------
City: -------------------------------------------- State: -------------------- Zip: ----------------
Email: ----------------------------------------------------------------------------------------------
Ph #: Mobile: ------------------------ Home: ---------------------- Work: --------------------
*Please indicate the method of payment: --- Check --- Cash
* Please indicate the payment frequency: -- One time -- Annually --- Quarterly --- Monthly
* Signature: ------------------------------------------------ Date: ----------------------------
* Payments by check should be made to:
Excelsior Alumni Association (USA) Inc.- LHS
* All payments should be mailed to:
Excelsior Alumni Association (USA) Inc.
c/o Dr Owen K. Jones
786 Lenox Road, Brooklyn, NY 11203
Email: info@xlcralumni.com
Excelsior Past Students’ Association (EPSA) Scholarships are designed for students in any stream pursuing studies in any field. We're looking to honor hard work, excellence, innovation, discipline and community involvement.
Thank you for your support
Excelsior Past Students Association- Jamaican Chapter.
137 Mountain View Ave.
Kingston 3 , Jamaica , W. I.
Email:xlcrpsasecretariat@yahoo.com,.....Or.....Peter......Moncrieffe, peter262@yahoo.com
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