contribution form in adobe pdf format

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the millennium

Contribution Form


* Required Fields
SEND DONATION RECEIPT TO:
* Name  : 
ESA Member No.  : 
[As it apears on credit card. Treasurer's name if chapter donation]
Chapter / Council Name  : 
Chapter / Council No.  : 
This DONATION should be credited to:
*  an individual a chapter
* Phone  : 
555 555-5555 (us) or 55 5555 5555 (au)
Fax  : 
* E-Mail  : 
* Address 1  : 
Address 2  : 
* City  : 
Country  : 
* State  : 
State/Province
(non US)		  : 
* Postal Code  : 
DONATION IS TO BE APPLIED TO:
$25 - New Member Fee  : 
$15 - Annual Dues  : 
$500 - LIFE Active Membership  : 
"Fantasy" Event  :  $
"Foundation Event at IC Convention"  :  $
General Fund  :  $
Robert & Dixie Palmer Recognition  :  $
  In Honor of  : 
Stewardship Recognition  :  $
  In Honor of  : 
Send me information on the Planned Giving Program  : 
I have placed the ESA Foundation in my Will and/or Estate Plans  : 

MEMBERSHIP DUES FOR OTHER
Name of member dues are for  : 
ESA number of member dues are for  : 
$25 - New Member Fee  : 
$15 - Annual Dues  : 
$500 - LIFE Active Membership  : 
MY DONATION IS
A Memorial for  : 
In Honor of  : 

SCHOLARSHIPS AND GRANTS
ADAPT Grant  :  $
General Scholarship  :  $
LIFE Grant  :  $
Morton Lester Memorial Scholarship  :  $
Outstanding Senior Youth Award Grant  :  $
Virginia Taylor Honorarium Scholarship  :  $

PERPETUAL ENDOWMENT SCHOLARSHIPS
Juanita Carter Adams Memorial / FL State Council Endowment  :  $
Alabama Past State Presidents' Memorial Scholarship  :  $
Alaska State Council Endowment  :  $
Alpha Chi #2055 ESA Endowment  :  $
Alpha Kappa / Jean Hall Scholarship  :  $
Alpha Kappa / Jean Varga Scholarship  :  $
Alpha Omicron AZ Endowment  :  $
Alpha Omicron #2520 Chapter Presidents  :  $
Alpha Upsilon #1884, Oregon Scholarship  :  $
Arizona Council Endowment Scholarship  :  $
Arkansas State Council Endowment  :  $
Charles B. Atchison Jr. Memorial Endowment  :  $
Ayers / Gallatin Endowment  :  $
Hope Baney Memorial Endowment  :  $
Ann and Bob Becker Endowment  :  $
Beta Chi Chapter of ESA Endowment (Edmond, OK)  :  $
Beta Omicron #842 Monte Vista, CO Endowment  :  $
Beta Zeta/Robert Glenn Rapp Foundation Endowment  :  $
Blue Ridge District Council VA Endowment  :  $
Raymond & Catherine Brizzolari Memorial  :  $
Billy Brockman Memorial Endowment  :  $
Em Bullock / California Memorial Endowment  :  $
Flora Burns / VA State Council Endowment  :  $
California State Council Past Presidents' Auxiliary Endowment  :  $
Eleanor Cannons Memorial Endowment  :  $
Gordon and Betty Cape Endowment for Continuing Education  :  $
City of Fountains (Kansas City,MO)  :  $
Eloise Collins Endowment  :  $
Colorado Lamplighters' Endowment  :  $
Alyce J. Corbin Scholarship Endowment  :  $
Jack & Lucille Crossno Memorial Endowment  :  $
Denton Family Honorarium Endowment  :  $
Shirley A. Dreyer Memorial Endowment  :  $
Joseph C. Eaheart, Jr. Endowment  :  $
Lucille Eastin Memorial Scholarship  :  $
Les & Rosalee Echele Honorarium Scholarship  :  $
Ellsworth Family Endowment  :  $
Epsilon Eta / Linda Cronin Memorial Endowment  :  $
Nancy Jo Fox Memorial Endowment  :  $
Charles H. Foy, Jr. Scholarship  :  $
Gamma Chi #3668 Loveland, Colorado Endowment  :  $
Vi Gardner Memorial Endowment  :  $
Georgia Men of ESA Endowment  :  $
Floyd Gray Endowment  :  $
Willow C. Gray Endowment  :  $
Ruth Elinor Gregg Memorial Endowment  :  $
Olive Griffith Memorial Scholarship  :  $
Carol Haas Scholarship  :  $
Marjorie J. Hamrick Memorial Endowment  :  $
Jerry Harvey Endowed Scholarship  :  $
Hawkins - Tuma Memorial Endowment  :  $
Helping Hands Scholarship of WSC  :  $
Neta Hendricks Memorial Scholarship  :  $
Wilhelmina M. & Richard W. Herbin Endowment  :  $
Doc & Cathy Holsted Honorarium Endowment  :  $
Rosagene Huggins Memorial Endowment  :  $
Lynn and Rich Hughes Family Endowment  :  $
Deborah Humphrey Scholarship  :  $
Jerry and Judith Huntley Endowment Scholarship  :  $
Illinois State Endowment  :  $
Indiana State Council Endowment  :  $
Peggy Jacques Memorial Scholarship  :  $
Joe Jaegers Family Endowment  :  $
Margaret Jesser Memorial Endowment  :  $
Bob & Jan Jones Endowment Scholarship  :  $
Zeta Jones Haldin Memorial Endowment  :  $
Suzanne Jourdan Memorial Endowment  :  $
Just Enterprises (York) Endowment  :  $
Kafoury and McDougal Personal Injury Endowment  :  $
Kansas Lamplighter Memorial Endowment  :  $
Kansas State Council Endowment  :  $
Kentucky State Council Endowment Scholarship  :  $
Frances C. Kilgore Scholarship  :  $
Hazel Knapp Endowment  :  $
Jan & Pete Lee Family Scholarship  :  $
Judy and Morton Lester Endowment  :  $
MARC Endowment  :  $
Jane Matthews Memorial Scholarship  :  $
McConnel Family Scholarship  :  $
Charline E. McCue Memorial Endowment  :  $
Kay McLaughlin Memorial Endowment  :  $
James McPherson Memorial Scholarship  :  $
Helen McSpadden Memorial Endowment  :  $
Dorothy & Jim Meade Endowment  :  $
Dr. Sidney E. Milburn Memorial Scholarship  :  $
Kay Mills Memorial Scholarship  :