first name

last name

maiden name (optional)

street address apartment #

city , state (eg. WI)

zipcode

class of? (eg. 1957 or 2001)

email address

telephone

fax

Is any of this information new?
  � No   Yes   

Donation Level: 

$25.00   |   $50.00   |   $100.00   |   $250.00 

$500.00   |   $1000.00   |   $Other

 Print out this page and send donation to :

 

Save a copy for your tax records – receipts will automatically be sent for donations larger than $250.00

If you have more questions about the Green Lake Country Foundation contact Eileen Connolly Keesler, Executive Director, Oshkosh Area Community Foundation at (920) 426-3993.