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Contribution Form


* Required Fields
SEND DONATION RECEIPT TO:
* Name  : 
ESA Member No.  : 
[As it apears on credit card. Treasurer's name if chapter donation]
Chapter / Council Name  : 
Chapter / Council No.  : 
This DONATION should be credited to:
*  an individual a chapter
* Phone  : 
555 555-5555 (us) or 55 5555 5555 (au)
Fax  : 
* E-Mail  : 
* Address 1  : 
Address 2  : 
* City  : 
Country  : 
* State  : 
State/Province
(non US)		  : 
* Postal Code  : 
DONATION IS TO BE APPLIED TO:
$25 - New Member Fee  : 
$15 - Annual Dues  : 
$500 - LIFE Active Membership  : 
"Fantasy" Event  :  $
"Foundation Event at IC Convention"  :  $
General Fund  :  $
Robert & Dixie Palmer Recognition  :  $
  In Honor of  : 
Stewardship Recognition  :  $
  In Honor of  : 
Send me information on the Planned Giving Program  : 
I have placed the ESA Foundation in my Will and/or Estate Plans  : 

MEMBERSHIP DUES FOR OTHER
Name of member dues are for  : 
ESA number of member dues are for  : 
$25 - New Member Fee  : 
$15 - Annual Dues  : 
$500 - LIFE Active Membership  : 
MY DONATION IS
A Memorial for  : 
In Honor of  : 

SCHOLARSHIPS AND GRANTS
ADAPT Grant  :  $
General Scholarship  :  $
LIFE Grant  :  $
Morton Lester Memorial Scholarship  :  $
Outstanding Senior Youth Award Grant  :  $
Virginia Taylor Honorarium Scholarship  :  $

PERPETUAL ENDOWMENT SCHOLARSHIPS
Juanita Carter Adams Memorial / FL State Council Endowment  :  $
Alabama Past State Presidents' Memorial Scholarship  :  $
Alaska State Council Endowment  :  $
Alpha Chi #2055 ESA Endowment  :  $
Alpha Kappa / Jean Hall Scholarship  :  $
Alpha Kappa / Jean Varga Scholarship  :  $
Alpha Kappa / Joann Zaleski  :  $
Alpha Omicron AZ Endowment  :  $
Alpha Omicron #2520 Chapter Presidents  :  $
Alpha Upsilon #1884, Oregon Scholarship  :  $
Arizona Council Endowment Scholarship  :  $
Arkansas State Council Endowment  :  $
Charles B. Atchison Jr. Memorial Endowment  :  $
Ayers / Gallatin Endowment  :  $
Hope Baney Memorial Endowment  :  $
Ann and Bob Becker Endowment  :  $
Bernhardt Family Scholarship  :  $
Beta Chi Chapter of ESA Endowment (Edmond, OK)  :  $
Beta Omicron #842 Monte Vista, CO Endowment  :  $
Beta Zeta/Robert Glenn Rapp Foundation Endowment  :  $
Blue Ridge District Council VA Endowment  :  $
BMW Scholarship of Hope  :  $
Raymond & Catherine Brizzolari Memorial  :  $
Billy Brockman Memorial Endowment  :  $
Em Bullock / California Memorial Endowment  :  $
Flora Burns / VA State Council Endowment  :  $
California State Council Past Presidents' Auxiliary Endowment  :  $
Barbara & Clayton Campbell Breast Cancer Endowment  :  $
Eleanor Cannons Memorial Endowment  :  $
Gordon and Betty Cape Endowment for Continuing Education  :  $
City of Fountains (Kansas City,MO)  :  $
Eloise Collins Endowment  :  $
Colorado Lamplighters' Endowment  :  $
Alyce J. Corbin Scholarship Endowment  :  $
Jack & Lucille Crossno Memorial Endowment  :  $
Andy Davis Memorial Scholarship  :  $
Denton Family Honorarium Endowment  :  $
Shirley A. Dreyer Memorial Endowment  :  $
The Harriette Dunckel Scholarship  :  $
Joseph C. Eaheart, Jr. Endowment  :  $
Lucille Eastin Memorial Scholarship  :  $
Les & Rosalee Echele Honorarium Scholarship  :  $
Ellsworth Family Endowment  :  $
Epsilon Eta / Linda Cronin Memorial Endowment  :  $
Nancy Jo Fox Memorial Endowment  :  $
Charles H. Foy, Jr. Scholarship  :  $
Priscilla Gale Memorial Scholarship  :  $
Gamma Chi #3668 Loveland, Colorado Endowment  :  $
Vi Gardner Memorial Endowment  :  $
Georgia Men of ESA Endowment  :  $
Wilbur & Vivian Gibson Family Endowment  :  $
Floyd Gray Endowment  :  $
Willow C. Gray Endowment  :  $
Ruth Elinor Gregg Memorial Endowment  :  $
Olive Griffith Memorial Scholarship  :  $
Carol Haas Scholarship  :  $
Marjorie J. Hamrick Memorial Endowment  :  $
James & Betty Hartung Scholarship  :  $
Jerry Harvey Endowed Scholarship  :  $
Hawkins - Tuma Memorial Endowment  :  $
Melvin & Lucille Haymaker  :  $
Helping Hands Scholarship of WSC  :  $
Neta Hendricks Memorial Scholarship  :  $
Wilhelmina M. & Richard W. Herbin Endowment  :  $
Doc & Cathy Holsted Honorarium Endowment  :  $
Pat Howard Memorial Scholarship  :  $
Rosagene Huggins Memorial Endowment  :  $
Lynn and Rich Hughes Family Endowment  :  $
Deborah Humphrey Scholarship  :  $
Jerry and Judith Huntley Endowment Scholarship  :  $
Illinois State Endowment  :  $
Indiana State Council Endowment  :  $
Peggy Jacques Memorial Scholarship  :  $
Joe Jaegers Family Endowment  :  $
Jay Peckham Pharmacy Scholarship  :  $
Margaret Jesser Memorial Endowment  :  $
Johnson Family Scholarship Fund  :  $
Bob & Jan Jones Endowment Scholarship  :  $
Zeta Jones Haldin Memorial Endowment  :  $
Suzanne Jourdan Memorial Endowment  :  $
Just Enterprises (York) Endowment  :  $
Kafoury and McDougal Personal Injury Endowment  :  $
Kansas Lamplighter Memorial Endowment  :  $
Kansas State Council Endowment  :  $
Kentucky State Council Endowment Scholarship  :  $
Frances C. Kilgore Scholarship  :  $
Hazel Knapp Endowment  :  $
Jan & Pete Lee Family Scholarship  :  $
Judy and Morton Lester Endowment  :  $
MARC Endowment  :  $
Jane Matthews Memorial Scholarship  :  $
McConnel Family Scholarship  :  $
Charline E. McCue Memorial Endowment  :  $
Kay McLaughlin Memorial Endowment  :  $
James McPherson Memorial Scholarship  :  $
Helen McSpadden Memorial Endowment  :  $
Dorothy & Jim Meade Endowment  :  $
Dr. Sidney E. Milburn Memorial Scholarship  :  $
Kay Mills Memorial Scholarship  :  $
Minnesota State Memorial Endowment  :  $
Missouri State Council Endowment  :  $
Missouri Torchbearers Scholarship Endowment  :  $
Montana State ESA Council Scholarship Endowment  :  $
Linda Moore Scholarship Endowment  :  $
Norma L. Moore Endowment  :  $
Doris Morris Scholarship Endowment  :  $
Johnnie & Tom Moseley Memorial Endowment  :  $
Nebraska ESA Endowed Scholarship  :  $
The New Mexico State Council Roadrunner Scholarship Endowment  :  $
Ohio State Council Nancy Waymire Memorial  :  $
Oklahoma Council District IV Scholarship  :  $
Oklahoma State Council District II Endowment  :  $
Oregon State Council Scholarship  :  $
Junior Paine Scholarship  :  $
Jeanne Parker Honorarium Endowment  :  $
Polk & Price Family Scholarship  :  $
Parr Family Endowment  :  $
Past IC Presidents' Endowment  :  $
Sharon Petelle Specific Learning Disability Scholarship  :  $
Kathy Quadrato Scholarship  :  $
Margaret Rader Memorial Endowment  :  $
Sherman & Nancy Reece Endowment  :  $
Jan Reppentine / AR State Council Endowment  :  $
Rho Chi #2988 - St. Charles, Missouri Endowment  :  $
Lauretta M. Roberts Memorial Endowment  :  $
Rocky Mountain Regional Council Endowment  :  $
Marjorie Rushford Endowment  :  $
Worda Russell Memorial Endowment  :  $
Joe and Kendra Sabol Family Endowment  :  $
Betty Sanders Scholarship Endowment  :  $
Immanuel & Irene Schaan Memorial  :  $
Schalvay Family Scholarship  :  $
Arlene Schlosser Memorial Endowment  :  $
Dennis Schlosser Endowment  :  $
Cora E. & Royal L. Scott Family Endowment  :  $
Letha L. Scudder Memorial Scholarship  :  $
Second Chance Endowment  :  $
SERC Endowment  :  $
Wallace & Magaret Shaw Memorial Endowment  :  $
Danzo & Elsie Shiramizu Scholarship Endowment  :  $
Phyllis Shoemaker Memorial  :  $
SHOW-ME State Endowment  :  $
Frances Shugart Endowed Scholarship  :  $
Dorothy Smith-Drumm Endowment  :  $
Sister of Georgia Memorial Endowment  :  $
Myre Starr Honorarium Endowment  :  $
Martha Stickland Scholarship Endowment  :  $
Rosemary Stormant Memorial Scholarship  :  $
Stormy Valley Scholarship  :  $
Ralph and Ruth Strother Scholarship Endowment  :  $
Survivors of Cancer or Catastrophic Diseases  :  $
Theta Zeta Fresh Start Endowment  :  $
Emily Thomas Memorial Endowment  :  $
Melvin & Anne Tracy Endowment  :  $
Tulsa Area Council Endowment  :  $
Dorothy Dyer Vanek Endowment  :  $
Elsie M. Vogler / Lois E. Carter Mem. Teaching Scholarship  :  $
Alice / Jeanne Wagner Perpetual Endowment  :  $
Leora Walton Endowment  :  $
Washington State Endowment Scholarship  :  $
Rodger & Rhea Weaver Endowment  :  $
Sandy Weisenberger Endowment  :  $
West Virginia Scholarship  :  $
Brenda and Wilbur West Endowment  :  $
Oscar & Joyce Whitewing Honorarium Endowment  :  $
Charles Wilsterman Memorial Endowment  :  $
Maxine Wirth Graduate Scholarship  :  $
Wisconsin State Council Endowment  :  $
Jacob & Barbara Wolf Memorial  :  $
LaVerne "Bun" Young Endowment  :  $

ALL CONTRIBUTIONS ARE TAX DEDUCTIBLE

RECURRING PAYMENTS

Recurring payments are made on the first of every month. The first payment is transacted on the first of the current or upcoming month.
How many payments would you like to make?  

TURN AROUND CHECKS
The check you send to the TURN AROUND FUND must be made payable to ESA FOUNDATION. [Checks or donations must be for $ 25 or more.]

Amount Name of Charity EIN #
$
$
$
$
$
$

NOTES:

  1. ALL Turn Around checks to St. Jude Children's Research Hospital will be given directly to the Circle of Life office for processing. If you would like it returned to you, please indicate that to us in writing. If you use Circle of Life or ALSAC / St. Jude materials / supplies for your event, you may NOT use the Turn Around Fund.
  2. A Turn Around Check cannot be issued directly to an individual. If checks are made payable to other than a recognizable charity, please briefly describe what the charity does. (i.e. Check to Jane Doe Fund / local community project for kidney transplant.)
  3. The Internal Revenue Service does not allow the Foundation to use Turn Around Funds for donations to the following: ESA Disaster Fund, State/Regional Love or Care Funds. Do not mail these checks to the Turn Around Fund.
  4. Turn Around checks cannot be re-written to a Chapter or State Council.