Platt Caddie Scholarship Donation Form

Donor Name: 
GHIN #: (if applicable)
Please note that our donation levels have changed. We have eliminated the "husband and wife" option and now offer one contribution amount per level. You may list a spouse or partner, in addition to yourself, in the bag tag space below. We also now offer a new level, Double Eagle, which is a $1,000 level of giving. Thank you for supporting our Caddie-Scholars!
Par $250 
Birdie $500 
Eagle $750 
Double-Eagle $1,000 
Lifetime $10,000   - or -     Installment (enter amount below) 
(enter amount below) 
Other (enter amount below)
Additional/Other Amount:
All levels will receive an engraved bag tag.
Were you a J. Wood Platt Scholarship recipient?   YES NO
Please use the lines below for identification in the Year in Review and on your engraved bag tag.
Name(s) as you wish to appear on the engraved Bag Tag:            
Club Affiliation (for brochure Listing):  
Name(s) as you wish to appear in the Year End Review: 
Total Donation:    
 I wish to make an online donation by credit card:
Name on Credit Card: 
Credit Card Type?Visa  MasterCard
Credit Card Number:  CVV:
Expiration Date:Month (MM):        Year (YYYY):
Billing Address:
City: State:   Zip: