Company Name:_________________________________________________

Address: ______________________________________________________

Contact Person & Title: _________________________________________________

Telephone: _______________________________

Fax: ____________________________________

E-mail: _________________________________________________

YES!! We are pleased to become a Kids' Chance Partner for the next 12-month period at the following level (check one):

_____ Senior Partner ($10,000) enclosed
_____ Junior Partner ($5,000) enclosed
_____ Sophomore Partner ($2,500) enclosed
_____ Freshman Partner ($1,000) enclosed

YES!! We pledge this level of support for   2    5   consecutive years.
(circle one if you wish to make a multi-year pledge.)

Please list our business/community group in all acknowledgement materials as follows:

_________________________________________________

Mail completed form and check to:
Kids' Chance of Pennsylvania
1231 Highland Avenue, Fort Washington, PA 19034

THANK YOU FOR PARTNERING WITH KIDS' CHANCE. YOUR SUPPORT WILL HELP DESERVING PENNSYLVANIA STUDENTS PURSUE THEIR HIGHER EDUCATION DREAMS.

Kids' Chance of Pennsylvania, Inc. is a is a registered 501(c)(3) not-for-profit, tax-exempt Pennsylvania charitable organization.