You are on page 1of 1

Donation Form

Thank you for your generous donation, benefiting Clare Housing and the Positive Care Center at HCMC! Please fill out this form completely and legibly. Donations are tax-deductible to the fullest extent of the law. Donations are non-refundable. We do not share or sell your contact information.

Participant Information
Participant you are sponsoring:

Your Information
Name: Mailing Address: City: Phone: E-mail Address: State: Zip Code:

Donation Information
Hero Champion Leader

Many companies match employee donations. Check with your employer for specific guidelines.

$ 1,000 Friend $ 500 Supporter $ 250 Donors Choice

$ 100 $ 50 $ _______

Donations should be made by check, payable to Clare Housing. Sorry, but we are unable to accept cash donations. This form must be included with all donations, and mailed to: Shut Out HIV 4805 Elliot Ave S Minneapolis, MN 55417
If you have any questions, please contact Tournament Director, Chris Larson, at: 612-600-0753 or chrisllarson@comcast.net.