To make contributions please print this form, fill it out and mail to council office.
An individual can make a donation to the Great Rivers Council Tribute/Memorial fund in memory of a loved one or in honor of a friend, associate, relative or just someone you would like to say thanks to in this way.

Donor(s) (your) name and address:

________________________________________________________________________
Your Name                Address                     City                          

________________________________________________________________________

State                     Zip

Donation is to be made in honor or memory of:

Recipients Name _________________________________________________

Reason for donation: deceased, anniversary, birthday, sick, job well done, thanks,congratulations, other (please circle one)?  Please use reverse side to give details.

To whom would like an acknowledgment letter sent to?

________________________________________________________________________
Name                Address                     City                          

________________________________________________________________________

State                     Zip

And what relation is this person (sent to person) to "The Recipient"? _______________________

Amount of donation _______________      Check or Money Order Number ___________
Cash? Yes / No (Not recommended to send cash through the mail).
Your name will be included in the acknowledgment letter and the Pilot, BUT not the amount of your donation.

MC/Visa Discover _________________________________________________

Expiration Date:_____________ Signature: _____________________________