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Mail in Donation Form

Instructions: 
• Fill in form, then use the link at the bottom of the page to print completed form. 
• Checks should be made payable to MCCF.
• If you are contributing to a specific fund, write fund name on Memo line of check.
• If your employer will Match your gift, please enclose completed form.

Mail to:
Middlesex County Community Foundation
211 South Main Street, Middletown, CT 06457

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I would like to add to:   

Arts Fund    Women & Girls    Karen A. Nelson Fund  

Live Local Give Local Fund   President's Discretionary Fund

Operations    Unrestricted Use    Carolyn R. Greenleaf Fund   

Ryan's Circle of Giving Fund    Patti Anne Vassia Fund for Administration

Other 

(Please write fund name on Memo line of check.)

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Amount Enclosed:

  $2,500    $1,000    $500    $250    $100    $50    $25  

                   (Checks should be made payable to MCCF.)

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Credit card donations:    Visa         MasterCard    

Card No.:   Exp. date:

Print name as it appears on card:

Signature of cardholder:  ________________________________________

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Matching Gift: 

    My employer will match my gift to the Community Foundation.

    Form is enclosed            Information to follow

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Contributions to Middlesex County Community Foundation
are tax deductible to the full extent of the law.
Please fill in the information below for your tax receipt.

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Name:

Business/Organization:

Address:

City, State, Zip:

Telephone:

Email address:

             Send me email updates             I/We wish to remain anonymous

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  This donation is in memory of:

  This donation is in honor of:

    Relationship to you (if any):

Please provide a name and address if you would like us to notify the
family / honoree of this gift. (Amount is not included.)

Name:

Address:

City, State, Zip:

    Relationship:

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Thank you for your support!
Middlesex County Community Foundation does not sell or share your information.

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