BCBA - Contribution Form

Please print and use this form for contributions. If making a memorial gift honoring a friend or family member, a thank you card will be sent to them in your name.

Once completed, mail your check and this form to:
BCBA c/o
656C N. Wellwood Ave. # 181
Lindenhurst, New York 11757

Please accept my contribution of $___________

Please make all contributions payable to: Community Boxing Center Inc.
PLEASE NOTE: Community Boxing Center Inc. is a NY State recognized Non- Profit Corp. doing business as- BCBA
EIN 11-3731446
Federal tax exempt status is pending
(i.e., recognition as a tax-exempt public charity pursuant to Sec. 501(c)(3) of the Internal Revenue Code)

Your Name: ______________________________________________________________________________

Address: ________________________________________________________________________________

City: ________________________________________ State __________ Zip __________________________

E-mail Address: _________________________________________________________ (To be held in privacy)

|_____| My gift is in the name of another

In Memory of: ____________________________________________________________________________

In Honor of: ____________________________________________ for the occasion of ___________________

_________________________________________________________________________________________

Please Notify :

Name ____________________________________________________________________________________

Address __________________________________________________________________________________

City__________________________________________State____________Zip__________________________

|___|

I've enclosed a statement of sentiment and support. You have my permission to place them on your website.

...We thank you for your generosity...