Return to Donations & Charitable Gifts Main Page.

Donation & Charitable Gift Form
Enclosed is my Gift to Washington, D.C. Chapter NRHS

Name:___________________________
Address:_________________________
Address:_________________________
City:____________________________
State/Province:__________________
Zip/Postal Code:_________________
Country: ________________________
Phone: day evening
 (____) - _________________
e-mail address:_________________

Today's Date: ____________

Please use my gift (please check one):

As it best fits the needs of the Chapter
For the project named below:

 _____________________

 

 

 

Please mail your gift to:

Washignton, D.C. Chapter NRHS
c/o Philip J. Kuhl
2121 Columbia Pike, Apt. 705
Arlington, Virginia 22204
 
TOTAL AMOUNT ENCLOSED:  $ ___________

PAYMENT METHOD  (please check one)::
 Check/Money Order payable to:
      Washington, D.C. Chapter NRHS
Charge my Visa Credit Card
Charge my Mastercard Credit Card
  My Credit Card Number is:
    
  Expiration Date: Month Year

Name on Credit Card: ____________________


__________________________________________
                           signature

THANK YOU!