Name: _____________________________________
Street Address: ______________________________
City: ______________________________
State: __________ ZIP Code: __________
Phone Number: _____-_____-_____
Email Address: ______________________________
I would like my name included on the FRCAP donor list: ___ Yes ___No
I wish to contribute the following:
____ $25 to sponsor one child
____ $50 to sponsor two children
____ $100 to sponsor four children
____ $625 to sponsor a classroom
____ Other amount, please specify: $ ___________
Additional Comments/Suggestions: _____________________________
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