WORLD TANG SOO DO FOUNDATIONBUILDING FUND Donation Form

Date: No:

Name:

Address:

2436 W Hanford Road, Burlington, NC 27215Phone (215) 468-2121 Fax (215) 336-2121

q 1 Brick $40 q Over $1,000 Donation q 2 Bricks $70 q $1,000 Donor’s Club* q 3 Bricks $100 q Other q $250 Donation

*Donations $1000 or over will be awarded aGrandmaster’s commemorative 26” sword.

Phone #: Assoc. #:

Studio: Region #:

Payment TypeVisa/Master Card #

Donor’s Certification Record Donor’s # Date:

Total contributions to date:

Check Expiration: Cash I agree to pay the “Donation Amount”

according to card issuer agreementPlease make checks payable to

“World Tang Soo Do Foundation”Signature

This contribution is TAX DEDUCTIBLE. Please keep this receipt for your records.

WORLD TANG SOO DO FOUNDATIONBUILDING FUND Donation Form

Date: No:

Name:

Address:

2436 W Hanford Road, Burlington, NC 27215Phone (215) 468-2121 Fax (215) 336-2121

q 1 Brick $40 q Over $1,000 Donation q 2 Bricks $70 q $1,000 Donor’s Club* q 3 Bricks $100 q Other q $250 Donation

*Donations $1000 or over will be awarded aGrandmaster’s commemorative 26” sword.

Phone #: Assoc. #:

Studio: Region #:

Payment TypeVisa/Master Card #

Donor’s Certification Record Donor’s # Date:

Total contributions to date:

Check Expiration: Cash I agree to pay the “Donation Amount”

according to card issuer agreementPlease make checks payable to

“World Tang Soo Do Foundation”Signature

This contribution is TAX DEDUCTIBLE. Please keep this receipt for your records.