ü YES, I WISH TO JOIN

THE WOMEN’S GIVING CIRCLE OF FREDERICK COUNTY!

Name:

Address:

City, State, Zip:

Daytime telephone:

Email:

q Check here to remain anonymous and not be listed on the Membership roster.

Membership Designation

While contributions to The Women’s Giving Circle of Frederick County Fund are accepted in any amount, membership begins with gifts of $1,000 a year for 3 consecutive years. Members may donate at that level or opt to give at a higher level. Please mark your cumulative level of giving.

I plan to give $__________________ a year for 3 years.

q Diamond: $5,000 or more

q Emerald: $3,001-$4,999

q Sapphire: $1,000-$3,000

q Junior Membership: Those under age 22, may join with a minimum contribution of $500 a year for 3 years.

Payment Information

q Check enclosed for my first year membership gift, payable to The Community Foundation of Frederick County with “Women’s Giving Circle” in the check’s memo. You will reminded annually for your subsequent membership contributions.

q I would like to pledge $ ___________ to be paid on _____________

q Charge my ___ MasterCard ___ Visa

Acct. #:

Expiration date:

Signature:

Contributions are fully tax-deductible to the extent provided by law.

Mail to: The Community Foundation of Frederick County

312 East Church Street, Frederick, MD 21701