San Angelo

FILL OUT THIS FORM AND SEND IN YOUR DONATION TO

ALCOHOL & DRUG ABUSE COUNCIL OF THE CONCHO VALLEY-ADACCV

P. O. BOX 3805

SAN ANGELO, TX 76902 

Please make checks payable to ADACCV and put SAPG-2008 on the Memo Line.

A receipt for tax purposes will be returned to you. 

 CIRCLE THE DONATION PLEDGE :

CAMPAIGN $20.08  

  COPPER   $25

     SILVER      $50

      *GOLD      $100

      *PLATINUM   $250 

OTHER_________________________

*IF YOU DONATE $100 OR MORE, YOU WILL GET YOUR NAME ON THE PROJECT GRADUATION T SHIRT AS AN EVENT SPONSOR.

Name as you wish it on the T-shirt

_________________________________ 

NAME_______________________________

ADDRESS____________________________

CITY_________________________________

ZIP_____________________

HOME PHONE________________________

CELL PHONE_________________________

EMAIL ADDRESS______________________

Circle area you would like to help  with:

ACTIVITIES

CHAPERONE 

DECORATIONS

FOOD

FUNDRAISING

PRIZES AND REWARDS

PUBLICITY

REGISTRATION AND VERIFICATION 

SECURITY AND CLEAN UP