- Pledge Form -

Last Name *    First Name *   Middle  
 
COMPANY:      Prefix Suffix  
 
   State* Zip *
     
         
X  
     
Please add me to your electronic mailing list.      
       

* = Contact Information (Required Fields)

By initializing below, I agree to honor
the terms of the pledge outlined on this form.


— PLEDGE INFORMATION —

Just fill in the amount you wish to pledge to the right of your choice

CAMPAIGNS

Facilities Fund $
Endowment $
Operational Reserve
 $
  (in Memory of Jack Buck)


SPECIAL EVENTS

Anniversary Awards &
Alumni Celebration
$
Coca-Cola Golf Tournament $
Jack Buck Celebrity
Night with the Stars
$
Maleness to Manhood $
Safety Weekend for Kids.. $
Say Amen Banquet. $
Sheer Elegance $
The Sky is the Limit $
TOTAL PLEDGE
(Please add up your pledges) 		$

PROGRAMS

Education $
General Operating $
Girls $
Health & Wellness $
Summer Day Camp $
Sports $

— PLEDGE INFORMATION —

Check sent separately to the attention of the PR & Special Events
Department at the address below
Please bill the above total to my credit card.  (I am calling in my credit card information)
Payment in the above amount is forthcoming.

Please keep my contribution anonymous.
Acknowledge Donation As:
I prefer that my contact information not be shared with parties outside this organization.

Initials: 


PRIVACY POLICY
The Mathews-Dickey Boys’ & Girls’ Club is a non-profit, 501 (c)3 organization and contributions are tax-deductible. Information collected via this document is utilized for the express purposes of Mathews-Dickey and will not be shared any other entity without the consent of the volunteer/member/donor. The Club maintains Internet firewalls on its servers to protect financial and other data. The make corrections to your contact information, please call Barbara Washington at (314) 382-5952, ext. 234.
Mathews-Dickey Boys' & Girls' Club
4245 North Kingshighway Blvd.
St. Louis, MO 63115
• Voice: 314.382.5952, ext. 234 • Fax: 314.389.3033
• E-Mail:  bwash-md@swbell.net • Web: www.mathews-dickey.com

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