Mathews-Dickey Boys' & Girls' Club Secure Order Form

Mathews-Dickey Boys' & Girls' Club

In honor of the Mathews-Dickey Boys' & Girls' Club's 50th Anniversary, you are invited to support our Golden Anniversary Campaign.
Your transaction will be confirmed by email.

Friend ($ 50)
       Give $1 for every year of our existence and support ongoing member programming.
Golden Giver
       I would like to pledge $ dollars a month for month(s).
       Payments will be processed once a month on the first day of the month.
Turn on the Lights ($ 1000 each)

Join the campaign to raise $50,000 in honor of the anniversary and support the annual operational costs.

GENERAL INFORMATION

First Name: Last Name:

(if applicable) Title:

(if applicable) Company:

Street Address:

City: State: Zip:

Country:

Work Number: Cell Phone:

(if applicable) Fax Number:
Home Phone:

E-Mail Address:

First Name:	Last Name:
(if applicable) Title:
(if applicable) Company:
Street Address:
City:	State: Zip:
Country:
Work Number:	Cell Phone:
(if applicable) Fax Number:	Home Phone:
E-Mail Address: