Tribute Gift Form

Where will your donation go?
 
  w In memory of                                                                                                                             
  w In honor of                                                                                                                                 
  w On the occasion of                                                                                                               
 

MY GIFT:                                                                                                                 

(Please make check payable to GSMB.)

          Name(s) _____________________________________________________

          Address _______________________________________________________

          City _______________________________ State_______ ZIP ____________

I would like to designate my donation to:   o Operations      o Endowment Fund

I prefer to charge my contribution to my (circle one) VISA / MasterCard.

Account #                                                                                                                     

Expiration Date                                                        
 

Please inform the individual/family/survivors:

          Name(s) _____________________________________________________

          Address _______________________________________________________

          City _______________________________ State_______ ZIP ____________

Return this completed form and check to:

          Girl Scouts of Mitten Bay, 5470 Davis Road, Saginaw, MI 48604

Call (989) 799-9565 or 1-800-968-1185, ext. 14 for more information.