ADOPT-A-SEAT
CHALLENGE
Application
        


Donor’s Name: ___________________________________________

Mailing Address: _________________________________________

_______________________________________________________
        
E-mail Address: ___________________________________________

Phone #: ________________________________________________

Donation Amount:     _______________________________________
 Seat plaque ($250)
 Wall Plaque ($1,000, $5,000, $10,000)         
        



SEAT PLAQUE INSCRIPTION
2 LINES only
Not to exceed 30 characters per line,
Including spaces, eg:
John and Jane Doe
And family


_________________________________________________________
        
_________________________________________________________



Note: Wall mounted plaque inscriptions will be arranged by individual donor