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