Name:
Company:
Address:
City:
State:
Zip:
Telephone:
Fax:
(Please include area code; with or without punctuation)
E-mail:
I would like to
donate the sum of
:
$
(Do not use commas or dollar signs; ex. 1000
or
50
or
25.50)
To the following fund:
Select the fund you wish to give to
Administrative Fund
Belvue Community Improvement Fund
Blue Valley Foundation Fund
Flint Hills Horse Park Fund
Havensville Community Improvement Fund
Leisure Land Playground Fund
Norton Community Improvement Fund
Pottawatomie County Economic Development Fund
Pottawatomie County Historic Preservation Fund
Pottawatomie Wabaunsee Regional Library Fund
St. George Historical Society Fund
St. Marys Friends of the Park Fund
The Ties That Bind Fund
Westmoreland Community Improvement Fund
