******* CAFAmerica™ Gift Form *******
(Please print and complete)

I would like to make a gift to CAFAmerica
Receipts will be sent for gifts of a greater value than or equal to $250. If the gift is by check, the receipt will be made in the name of the person signing the check.
Name(s) of donor(s)

[Mr. Mrs. Ms.]..........................................................................................
Address of donor(s) .................................................................................................................
.................................................................................................................
...................................................... Zip Code ...........................
Telephone ........................... Fax ........................... E-mail ...........................
Name(s) of donor(s) to be acknowledged to suggested charity: .....................................................
 

Please check whichever applies and fill in the amount
I enclose a check payable to CAFAmerica in the amount of

$ .............................

I enclose a description of a non-cash gift and confirm that details have been notified to CAFAmerica

Please charge

$ ...................

 to my

Master Card

 Visa
(These cards carry an extra 4% fee)
Name exactly as on card ...................................................... Exp. Date ...........................
Account number .................................................................................................................
Signature .................................................................................................................

 

Please check whichever applies and complete

Please use my gift as CAFAmerica believes it is most needed

 or
Please use my gift to support the following area of service (youth, families, aged, AIDS, environment, etc.), country, or region of the world:

.................................................................................................................

 or

I would like to suggest that CAFAmerica support the following philanthropic organization:

Name of Organization

 The Miscarriage Association
Address c/o Clayton Hospital, Northgate,
Wakefield WF1 3JS, England
Telephone Number 01924 200795 Fax number 01924 298834
Contact name & title Ruth Bender Atik, National Director
Activities of organization Provides support and information on pregnancy loss

 

I understand that my gift to CAFAmerica becomes the property of CAFAmerica and that CAFAmerica has ultimate control, authority and discretion with regard to its assets. All grants made by CAFAmerica are its sole and independent discretion.
Signature: ...................................................... Date: ......................................................

 

Please make copies of this form as needed. Please send the form(s) together with your gift(s) to:

Gift Administrator, CAFAmerica, King Street Station
1800 Diagonal Road, Suite 150, Alexandria, VA 22314-2840
Fax: (703) 549-8934   E-mail: cafamerica@caf.charitynet.org