Literacy Donation Form

Donation Amount: ___________________

(Minimum of $3.00 donation)

Donor Name: _______________ Club #: ________

Please print this form, fill it out and mail it according to the instructions below

Happy Birthday ___________

Anniversary _____________

In Honor Of: _____________

In Memory of: ___________

Thinking of You: __________

Congratulations: __________

Recipient: _________________________________________

Address: __________________________________________

City: ____________________ State: ________ Zip: _______

 

Please type or print clearly:

 Send To: PSP Pamela Shirkey - Supreme Literacy Chairman
               6649 Magical Drive
               Sparks, NV 89436-7171

Make Checks Payable to:  Supreme Literacy Scholarship

Your canceled check is your receipt.

Please print this form, fill it out and mail it according to the instructions below