Mailing Address: __________________________________ Phone: __________________
City: ____________________________________ State: _______ Zip: _________________
Enclosed is my gift in the amount of: $___________________
Please make checks payable to Rockport-Fulton Good Samaritans, Inc.
This gift is given: £ As an unrestricted gift
£ As a contribution to Kid Care
£ As a contribution to Christmas Baskets
If this donation is a gift or memorial:
(please choose one) £ In Memory of: _________________________________
£ In Honor of: ___________________________________
Please send a notification to person listed below.
Mailing Address: ___________________________________________________
City: ____________________________________ State: _______ Zip: ________
£ I would like more information about Good Samaritans.
£ I would like to be called about volunteering.
£ I would like a speaker for my club or organization.
Group name: _______________________________________________________
Group contact person: ___________________________ Phone: _____________
Please return this form to:
Rockport-Fulton Good Samaritans, Inc., 507 South Ann Street, Rockport, Texas 78382
Thank you for your contribution.
All contributions are tax deductible to the extent permitted by law.