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Yes, I want to Help!

Please fill out and print and return with your tax deductible donation:

_________________________________
Name

_________________________________
Address

_________________________________
City State Zip

_________________________________
Phone

_________________________________
Email

Please accept my five-year tax deductible pledge or gift of:

___ $2,000 ___ $1000 ___ $500 ___ $250 ___ $100 ___ $50

Please accept a one-time contribution $____________

Check is enclosed ____

Donation by credit card, please contact me directly for card information.

Please print and return with your tax deductible donation to:

Shuttleworth Park Foundation Inc.
PO Box 503 • Amsterdam NY 12010

Thank you for making a difference!