Thank you for being an "Element of Success!"

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Please complete the form below and submit. Once you click the "Submit" button, you will be redirected to the University of Michigan's giving website to complete your transaction. All gifts must be greater than, or equal to, $1000 and paid in full. No pledges will be accepted.

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First Name *

Last Name *

Element Number (Auto-populated/Do not edit) *

Donation Amount *

Element Display Details

Complete this section to input the text you would like displayed on your element. There is a maximum of three lines of text available, each containing 17 characters (including spaces).

First line of text (Limited to 17 characters)

Second line of text (Limited to 17 characters)

Third line of text (Limited to 17 characters)

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