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                                              Donaton Form

 




(Please Print)

Name: _________________________________________________________________________________

Organization/Business Name: _______________________________________________________________

Address: _______________________________________________________________________________

City, State, Zip Code: ______________________________________________________________________

Telephone Number: _______________________________________________________________________

Fax Number: ____________________________________________________________________________

E-mail Address: __________________________________________________________________________

Amount Enclosed: $___________.__________   Date Sent:________________________________________

Comments:

Mail this upper section with your check or money order to:
DDCNJ -54 Foxwood Rd, Lakewood, New Jersey 08701-5728

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Please retain the section below for your records. Note: Diverse Deaf Club of NJ, Inc is a non-profit organization; your donations are tax deductible. We will gladly provide you with a receipt for your tax records. Asking for Michelle Busanic at topazmib@aol.com.

Mailed donation form to: DDCNJ - 54 Foxwood Rd, Lakewood, New Jersey 08701-5728
 

Amount Donated: $___________._______   Check Number: ___________

Date Sent:______________

Thank you for your donation.