CIS Donation Form

DONATION FORM

Yes, I want to help students stay in school and prepare for life!

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Donor Information

* Title:

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* City:

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Special Event - Lowcountry On the Green
Saturday , September 18, 2010

Number of guests attending at $75.00 per person

Total Amount Due
(Please complete credit card information below)

Donation Amount and Payment Information

* Donation Amount:

Credit Type:

Mastercard Visa

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example: 4111222233334444
no dashes

Expiration Date:

Card Security Code*:
*(On Visa/MC/Discover, the 3-digit number on back of card)

All contributions are fully tax deductible within the limits of federal and state laws.

Designation Information

Gifts to Communities In Schools are a meaningful way to
remember someone special. To make your gift in honor
or memory of someone, please complete the following:

In Memory of

In Honor of

Please send notice of this gift to:

Name:

Address 1:

Address 2:

City:

State:

Zip Code:

Thanks for joining our effort to help students stay in school and prepare for life!

If you have any questions, please email Romy Graham at
rgraham@cischarlotte.org or call (704) 943-9446