GIFT FORM

Enclosed is my gift of:		_______________________________________________
From:		_______________________________________________
Mailing Address:		_______________________________________________
		_______________________________________________
This gift is a (please check one):		Donation   In Honor of   In Memory of
Name:		_______________________________________________
Please Notify:		_______________________________________________
Address:		_______________________________________________
		_______________________________________________

Please add my name to the database of LaCrosse Dollars for Scholars Alumni & Newsletter recipients. Year of graduation ________

Check here if you wish to use your check as acknowledgement of your donation and not receive a separate acknowledgement letter. We will still notify the family of any current memorial donations.

Notification of your gift is sent promptly. The amount is kept confidential. All gifts are tax deductible in accordance with the law.

Please make checks payable to:		Lacrosse Dollars for Scholars
Send this form to:		Lacrosse Dollars for Scholars P.O. Box 258 Lacrosse, WA 99143