A Founding member makes a five year commitment for an annual $1,000.00 donation.

Please print and mail this form with your payment:

Greene County 100 Club
321 E. Chestnut Expressway
Springfield, Missouri 65802


Name:_____________________________________________

Address:___________________________________________

City:_______________________ State:_____ ZIP:__________

I wish to give to the 100 CLUB in the amount listed below:

[  ] Founding Member: a five year commitment of $1000.00 annually

[  ] Founding Member: a one time payment of $5000.00


Contributions are tax deductible.

 
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