RUSSIAWELLNESS FOUNDATION
Gift Form
The enclosed is my gift of $_________________ to be used for:
Please make checks payable to: Community Foundation of Shelby County. Please add “Russia Wellness Foundation” to the memo line.
___ Russia Community Fund (unrestricted grant making fund)
___ I wish to establish a new charitable fund with this gift.
___ Russia Wellness Facility Fund (TRACK)
___ Other:
Mail to:
The Community Foundation of Shelby County
100 South Main Avene
Ste. 202
Sidney OH 45365
Given by:
______________________________________________________________
Address: ________________________________________________________________
City: _______________________ State: _________ Zip: ___________
Telephone: _________________ Email: _______________________
If
Gift Form
The enclosed is my gift of $_________________ to be used for:
Please make checks payable to: Community Foundation of Shelby County. Please add “Russia Wellness Foundation” to the memo line.
___ Russia Community Fund (unrestricted grant making fund)
___ I wish to establish a new charitable fund with this gift.
___ Russia Wellness Facility Fund (TRACK)
___ Other:
Mail to:
The Community Foundation of Shelby County
100 South Main Avene
Ste. 202
Sidney OH 45365
Given by:
______________________________________________________________
Address: ________________________________________________________________
City: _______________________ State: _________ Zip: ___________
Telephone: _________________ Email: _______________________
If