Mail in Contribution form to support Albert Galatan's Bike Ride to Support The Elija School for children with Autism
CLICK HERE FOR CREDIT CARD FORM
Donation Amount: $_________________________________
Sentiment or Additional Comments:
Total amount enclosed $________
Name (s) _______________________
_______________________________
_______________________________
Address _________________________
_______________________________
Phone ______________________ Email_______________________
Organization or Affiliation (ie: Parent,Speech,Teacher)_____________________
Send Check or Money Order Payable to:
Friends of the Elija School
665 Newbridge Road
Levittown NY 11756
We also take Visa/Mastercard (circle one) Acct#____________________________ Exp Date:________
Card Holders Signature: _____________________________
Phone:516 433 4321 Fax 516 433 4324 (for information or questions only. Do not fax a reg form)
