Manasota ARC • 3659 Cortez Road, W. • Suite 110 • P.O. Box 9292 • Bradenton • Florida • 34206

Please print this form, complete it, attach your contribution* and mail to the address above.

_____  YES!  I would like to help support Manasota ARC.

_____  Please send me information about naming Manasota ARC in my will.

_____  I have already made provisions for Manasota ARC in my estate plans.

_____  I am interested in becoming a volunteer.

_____ Member $30.00    _____ Family $50.00    _____ Friend $250.00

_____ Cornerstone Partners $1,000.00    _____ Foundation Partners $5,000.00

_____  Other:  $____________

Member\Volunteer Contact Information:

Name: ____________________________________________________

Company Name:  __________________________________________

Address:  _________________________________________________

City, State Zip:  ____________________________________________

Phone/Fax:  _______________________________________________

Email:  ___________________________________________________

ALL DONATIONS ARE APPRECIATED, THANK YOU!

*Please make check payable to:  Manasota ARC
 Manasota Association for Retarded Citizens (a non-profit organization)