| Tribute/Memorial Form |
Print this form and mail it with your donation to: Assistance League North Coast
PO Box 2682
Carlsbad, CA 92018-2682
Date:_________________
I would like to honor:
This a Memorial ____or Tribute_____
__________________________________________________________
Name in Full (please print)
Donor Information:
Name____________________________________________________________
Address__________________________________________________________
City _________________________ State______ Zip ________
Telephone( )___________________________
Please send an acknowledgement to: (person whom you wish to notify of your gift)
Name____________________________________________________________
Address__________________________________________________________
City _________________________ State______ Zip ________
My check is enclosed for $ __________.
Please make check payable to Assistance League North Coast.
Please charge my credit card (Visa/Mastercard)
Card number__________________________________
Expiration Date___________ Amount $_____________
Billing address__________________________________________________
Signature____________________________________________________
Your generosity is greatly appreciated and will make a difference in the lives of
North County residents in need.
Assistance League North Coast publishes donor names and/or amounts in various publications viewed in the
community. Please indicate your wishes regarding this information below. Sample publications and our full privacy
policy are available for your review in our office
or on our website.
___You may publish my name only
___You may publish my name and donation.
___ Do not include any information as I wish the donation to remain anonymous.
Signature_____________________________________
Would you like to receive an invitation to our Autumn Fantasy fund raiser each year? Yes___ No__
PO Box 2682
Carlsbad, CA 92018-2682
Date:_________________
I would like to honor:
This a Memorial ____or Tribute_____
__________________________________________________________
Name in Full (please print)
Donor Information:
Name____________________________________________________________
Address__________________________________________________________
City _________________________ State______ Zip ________
Telephone( )___________________________
Please send an acknowledgement to: (person whom you wish to notify of your gift)
Name____________________________________________________________
Address__________________________________________________________
City _________________________ State______ Zip ________
My check is enclosed for $ __________.
Please make check payable to Assistance League North Coast.
Please charge my credit card (Visa/Mastercard)
Card number__________________________________
Expiration Date___________ Amount $_____________
Billing address__________________________________________________
Signature____________________________________________________
Your generosity is greatly appreciated and will make a difference in the lives of
North County residents in need.
Assistance League North Coast publishes donor names and/or amounts in various publications viewed in the
community. Please indicate your wishes regarding this information below. Sample publications and our full privacy
policy are available for your review in our office
or on our website.
___You may publish my name only
___You may publish my name and donation.
___ Do not include any information as I wish the donation to remain anonymous.
Signature_____________________________________
Would you like to receive an invitation to our Autumn Fantasy fund raiser each year? Yes___ No__