I want to help students in Bethlehem!

SCHOLARSHIP FUND DONATION FORM

To send contributions for the scholarship fund, please fill out the form below,
Print it then press the submit button to send your pledge and obtain a confirmation.
- Sign the printed form and mail it with your check to the address
  below, we will send you a tax-deductible receipt once it is received.
  - The Bethlehem Association Scholarship Fund,
    P. O. Box 1111, MEDIA, PA. 19063, U.S.A.

I would like to make the following contribution to the Scholarship Fund:

        Amount $ (US$ only)
Check #      (Payable to Bethlehem Association Scholarship Fund. )
Credit Card:   Visa        Master Card

Exact Name on Card	Card #: Count 16 -20 digits

Expiration Date:	Month/Year
Signature:		*Date:*

Check one: This is a one time contribution.
                        I pledge to contribute the same amount each year until the
                              student graduates within four years.
                     I am interested in establishing my own family scholarship, please call me.

Name

Address

Email

Phone:

Day Evening Fax

Date:

Press submit button to send info and obtain confirmation

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Phone:
Phone:	*Day*	*Evening*	*Fax*
Date: