WHEELCHAIR PROJECT DONATION FORM

Mr. Peter T. Cooper, President
Community Foundation of Greater Chattanooga, Inc.
1270 Market Street
Chattanooga, TN 37402

Dear Pete:

I am pleased to support the Wheelchair for Peace project of the Rotary Club and Sister City Association of Chattanooga as a donor of_____ wheelchairs. My check in the amount of $75 for each wheelchair donated is enclosed, payable to the Community Foundation, a 501(c)3 public charity. I understand that I will receive an acknowledgment for tax purposes from the Foundation.

Donor's Name________________________________ (Please print)

Donor's Address______________________________________________

City ______________________ State_____ ZIP____________

Chair #______In Honor Of / In Memory Of______________________

Presentation Folder to be sent to_________________________________

Address ______________________________________________

City _____________________ State _____ ZIP___________

Chair #______In Honor Of / In Memory Of______________________

Presentation Folder to be sent to_________________________________

Address ______________________________________________

City _____________________ State _____ ZIP___________

Chair #______In Honor Of / In Memory Of______________________

Presentation Folder to be sent to_________________________________

Address ______________________________________________

City _____________________ State _____ ZIP___________

Chair #______In Honor Of / In Memory Of______________________

Presentation Folder to be sent to_________________________________

Address ______________________________________________

City _____________________ State _____ ZIP___________

PRINT THIS FORM FOR DONATIONS OF ONE TO FOUR CHAIRS
PRINT ADDITIONAL COPIES FOR MORE THAN FOUR WHEELCHAIRS