H.E.R.O. Program 6

(This could appear in the newspaper - or whatever medium is used - with information and for the donor to complete and return).                                                                                                                                                                                 H.E.R.O. Program

Date_______________________

Product, Service, or Money Requested___________________________________

______________________________________________________________________________________________________________________________________

Description or Explanation of Solicitation_________________________________

___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________

Procedure for Donating: Send check to___________________________________

                                         or contact________________________________________

                                         if you desire to contribute a service, product, or have any

                                         questions.

Important: Sign below on the dotted line if you wish your money to be used for all  

                     alternative charitable requests should donations for your selection

                     exceed the cost. Otherwise, your check will be returned to you.

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If possible, do you want your name and reason for involvement to be known? ___

Please print your name________________________________________________

State your reason (e.g. in memory of, in order to, etc.)_______________________

___________________________________________________________________