The Community Foundation of the Virginias, Inc.

              (Print out this page, fill it out, and mail it in with your check)

You will find enclosed $ ________________________

As a gift from ________________________________________________

                           Print your name as you would like it to appear in Foundation publications

___________________________________________________________

Address                                                               City                                            State             Zip

 

Check items below, as appropriate

__ Please apply this gift to Unrestricted Funds.

__ Please apply this gift to the following Field-of-Interest or Endowment Fund

        _______________________________________________________

__ Please apply this gift to offset administrative expenses.

 

Please apply this gift:

__ In memory of ______________________________________________

__ In Honor of ________________________________________________

__ As a Contribution ____________________________________________

__ Without reference to the amount

__ Please send additional information on establishing a named Endowment Fund.

 

Make your check to: The Community Foundation of the Virginias, Inc.

                                           PO Box 4127

                                           Bluefield, WV 24701