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: _______________________