After Printing, click here to return to the main FOCUS donation page.

Name

________________________________________________________

Address

________________________________________________________

City

___________________

  State _______

Zip________________

Phone

___________________

Email ________________________________

Method of Payment: Check

Amount

$_____________


Checks should be made payable to FOCUS and mailed with this form to:

 

FOCUS

238 W. Washington Street

Charles Town, WV 25414
 
 

I would like my contribution to support this FOCUS program:

When Youth Create (Youth & the Arts)

Tobacco Prevention

Drug Prevention

Alcohol/Drunk Driving Prevention

Violence Prevention

Community Events (Sound Lounge, Teen Nite Out)

School Clubs (AWESOME Club, RAZE)

General Operating Funds

 

I would like my contribution acknowledged as follows, with a letter mailed:

In Memory of:

Name: __________________________________________

With Notification to: ________________________________

Address: ________________________________________

In Honor of:

Please include do not include my name when you thank your donors in FOCUS publications or on the website.

Thank you for your kind support of FOCUS, a 501(c)(3) organization. Contributions in any amount are tax-deductible to the full extent of the law.