Thank you for your gift--together we do make a difference. 
Single contribution:  [ ]$25    [ ]$50    [ ]$100    [ ]$250    [ ]Other ____________
Monthly pledge:       [ ]$10    [ ]$25    [ ]$50     [ ]$100    [ ]Other ____________			
		I understand that I can change or cancel this at any time.	
		[ ]I will be paying by check.  Please send me reminders monthly.
		[ ]I will pay by credit card and authorize this amount 
                    to be withdrawn monthly.
					
Payment
[ ]I am paying by check or money order, made payable to The Atwood Community Center 
[ ]I am paying by credit card:  [ ]Visa    [ ]Mastercard    [ ]Discover
                                Name as on card ________________________________________
                                Card# _______________________________  Exp. ____________
                                Signature ______________________________________________


Other considerations
[ ]Please make this gift in honor of ___________________________________________________
[ ]Please make this gift in memorial to ________________________________________________
[ ]I'd like this gift to remain anonymous
A tax receipt will be issued for each single contribution. Pledge receipts will be mailed at the end of the year.
The Atwood Community Center is a non-profit agency. Your contribution is tax-deductible to the full extent allowed by tax laws.
..............................................................................................................................................................................
Where would you like us to dedicate your gift?
You may split your gift among different programs by indicating the amount for each. Please print clearly.
_______The One Family Campaign to help the Center move to their new facility             
         [ ] I/We would like a small yard sign (8 x 8") to make our support public.
             Please drop one off at the address below.
                  Note: The Center will do its best to deliver signs throughout the Madison area, but will be unable
                                   to mail them to distant supporters.
_______Where it is needed most to support the Center's mission
_______To support a specific program area: ___________________________________________ ..............................................................................................................................................................................
Your information 
Name/s________________________________________________________________________________
 
Address____________________________________________  Email____________________________
 
City_________________________________  State___________________________  Zip__________
 
Home Phone____________________ Work Phone__________________ Cell Phone________________
 
Other Updates/Corrections_____________________________________________________________



2425 Atwood Avenue
Madison, WI 53704
Phone (608) 241-1574
Fax (608) 241-1518
www.goodmancenter.org 		FOR GACC OFFICE USE ONLY

Date received _____________
Date RE _________________
IFA_AC1106

Check # __________
Date TY__________