Please print this page, fill it out and send it along with your donation to the address at the bottom of this page.
Yes, I want to make a tax deductible donation to The Starlight Children's Foundation and help a sick child.
Donations of any amount are welcome and appreciated!

_________________________________________________
Name

_________________________________________________
Company (for Corporate Sponsorship)

_________________________________________________
Address

_________________________________________________
City/State/Zip

_________________________________________________
Country/Telephone

I would like to contribute the following amount: $___________

I would like more information on becoming a corporate sponsor for the New England Chapter _______

I would also like to contribute to the following specific area:

_____ Help a seriously ill child by providing hours of diversion by sponsoring a Child's Wish! $3,500

_____ Help entertain several hospitalized children by sponsoring a Starlight Fun Center. $3,200

I would like to make a donation in the memory of: ___________________.

Please send acknowledgment to :_________________________.

I would like to make a donation in honor of ___________________ for occasion _______________.

Please send acknowledgment to: ___________________________________.

I would like to receive information on planned giving to Starlight" _____________________

I am paying by:

____ Check/Money Order____ VISA____ MasterCard____ American Express

Card No: _____________________________ Expiration Date: ___________

Charge my card:

once ____ monthly ____ quarterly ____ annually ____

Cardholder Signature: ___________________________________________

Cardholder Name (Please print): _________________________________