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PACER Center
952-838-9000

Champions for Children with Disabilities

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Donation Form

Thank you for helping PACER Center carry out programs for children and adults with disabilities

Please send completed form and contribution to: PACER Center, 8161 Normandale Blvd., Minneapolis, MN 55437

I support PACER's programs for parents of children and young adults with disabilities and their families. Enclosed is my tax-deductible contribution, payable to PACER Center, Inc. (please circle one):

$5000 $1000 $500 $200 $100 $50 $25 Other:$____

Method of donation payment (please circle one):

Check Master Card Visa American Express

Credit Card #_______________________________  Expiration Date __________

Name_______________________________

Phone (H)________________ (W) __________________

Address___________________________________________

City, State, Zip__________________________________________



Double your gift! Many companies match gifts. Ask your employer for a matching gift form and enclose it with your contribution.

Please use my gift:

Check Box Where it is needed most. Check Box Program__________________
Check Box In memory of ______________________________
Check Box In honor of ________________________________
Occasion:__________________________________
Check Box Please send acknowledgment to:
Name_________________________________________________
Address_______________________________________________
City, State, Zip____________________________________
Check Box Do NOT include my name on PACER's list of donors.
Check Box Please send information about how I may include PACER in my will.

Visit PACER's other sites: Teens Against Bullying | Kids Against Bullying | FAST Family Support | FAPE | MN SEACs

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