To donate by mail to Children's Home Society of Washington, please print, fill out and mail this form to:

Fund Development Office
Children's Home Society of Washington
P.O. Box 15190
Seattle, WA 98115

I want to support Children's Home Society of Washington to ensure a brighter future for children. Enclosed, please find my check made payable to CHSW in the amount of (please fill in appropriate line):

Second Century Club
$1,000 +
$ __________

Ambassador
$500 - $999
$ __________

Guardian
$250 - $499
$ __________

Investor
$100 - $249
$ __________

Supporter
up to $99
$ __________

Name _______________________________________
Address _____________________________________
City __________________State _______ZIP ________
Day Phone __________________
Evening Phone ______________
Email ________________________________________

I may be contacted by e-mail.
Please do not contact me by e-mail.

Please accept my gift in recognition of the following:
Memorial
Anniversary
Birthday
Holiday
Other

Person Honored ________________________________

Please send an acknowledgment card to:
Name ________________________________________

Address ______________________________________

City ______________State _________ZIP ___________

I am interested in becoming a regular (monthly/quarterly) contributor.
My employer will match my gift, enclosed is my matching gift form.
I have remembered CHSW in my will.
I am interested in information on the advantages of planned giving.
Please do not include my name on published donor lists.