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Donation Form

"Help Crèche Help a Needy Child"

Mr./Ms./Mrs Name(s):
Email:
Phone #:
Address:
Enclosed is a gift of:
Signature:
Date:
Please Direct This Gift To:
Memorial Gift:	In Memory Of: Send Gift Acknowledgement: Name: Address:

All gifts are tax deductible. Please make checks payable to: The Crèche

Please return complete form with your check to:

The Crèche
Assistant Treasurer
P.O. Box 0601
Jamestown, NY, 14701

Thank You!