WEED COMMUNITY CENTER PRINTABLE DONATION FORM

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Yes, Count me among the Community Center Support Team.

     Name (please print)  _____________________________

     Address/City/Zip  _______________________________

     Tele. Bus/Home  ______________ Best time to call  __________

     Email  _______________

I would be interested in serving the community: (please check all that apply)

   FOUNDING INVESTOR                  FOUNDING CONTRIBUTOR
   ____ PLATINUM $2500 or more        ____ OAK $250
   ____ GOLD $1000                             ____ CEDAR $100
   ____ SILVER $500                             ____ PINE Under $100 
                                                              ____ PIGGY BANK 18 years & under, any amount
                                                                                                       

Payment method: ___One Pmt; ___2 Semi-annual Pmts; ___4 qtrly Pmts; ___12 Monthly       

                                                                      THANK YOU


Please Mail Payments to: Weed Community Center:  P. O. BOX 627, Weed, CA 96094                                                       

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