Jack Fanning Memorial Foundation Angels for Autism

Levels of Giving
If you would like to make a contribution, please print out this form and send it with your check made payable to The Jack Fanning Memorial Foundation to:

The Jack Fanning Memorial Foundation, 307 Bordeaux Ln., Cary, NC 27511

_________________________________________________________________________
name (as you wish your name to appear in our donor publications)

_________________________________________________________________________
address

_________________________________________________________________________
city state zip

My/Our Gift of Caring is designated below:

_____ Firefighter - Ladder 59

_____ Lieutenant - Ladder 26

_____ Captain - Engine 332

_____ Battalion Chief - Chief of Haz/Mat Ops

_____ Deputy Chief

$ 50 - $ 249

$ 250 - $ 499

$ 500 - $1499

$1500 - $4999

$5000 +

$ _______

Please consider my contribution a:

_____Gift Tribute (birthday, wedding etc.) _____ Memorial Gift _____ Other ___________

If this gift is made in someone’s honor please fill out the following so that we may inform them of your thoughtful gift:

Honoree’s Name: __________________________________________________________

Acknowledgment (please provide us with a name, address, and any additional information here):
_________________________________________________________________________

_________________________________________________________________________

At this time, we are only able to accept checks. We apologize for any inconvenience.

The Jack Fanning Memorial Foundation is a 501(C)(3) Charitable Organization. All contributions are tax-deductible.