1. Contact Information: First Last Name: Address: City: State: Zip Code: Home (xxx-xxx-xxxx) Work (xxx-xxx-xxxx) Phone: E-Mail:
2. Completing your Contribution:
Donation amount: $ (U.S. Funds Only)
3. Please mail this form and your donation check to the following address:
NWCCD Scholarship Fund c/o Debbie Peterson PMB #369 17675 SW Farmington Rd Aloha, OR 97007-3296
All contributions are tax deductable and a tax deductable receipt will be mailed to you. .
Thank you so much for your contribution, and may God richly bless you!