Thank you for you tax deductible contribution:


____ $1000 ____$500 ____$100 ___$50 ___$25 Other_________________

Please print your name and address:

Name: __________________________________________________________

Address: ________________________________________________________

City________________State/Country____________Zip/Postal Code________

Phone number:______________________

E-mail address_________________________

Method of Payment: ___Mastercard ___Visa ___Check

_____________________________________________________
Credit Card # (MC or Visa only) exp date

___________
3 Digit Security Number
[back of card next to signature]

_____________________________________________________
Signature



If you would like your contribution to be in honor or memory of an individual or family, please designate their name(s) below.

In memory of:__________________________________________________

In honor of: ____________________________________________________



Identify below who you would like to be notified of your thoughtfulness:
Name:_____________________________________________________________

Address: ___________________________________________________________

City________________State/Providence____________Zip/Postal Code_________