UCP/NYC Printable Donation Form

I want to make a contribution to United Cerebral Palsy
of New York City:

Name ___________________________________________

Address _________________________________________

City _________________________ State ____ Zip ________

Telephone _______________________________________

Please accept my gift in the amount of $_______.

I want to become a monthly sponsor at $ ____ per month.

For Memorial or In Honor Of Gifts:

My gift is in memory of ____________________

My gift is in honor of ___________________

Occasion _________________

Please send acknowledgment card to:

Name ___________________________________________

Address _________________________________________

City _____________________ State ______ Zip __________

Please sign my card from: ___________________________

To Charge Your Gift:

__American Express __MasterCard __VISA

Acct.# ____________________________ Exp. Date _______

Signature__________________________________________

Check here if your company has a Matching Gift Program. (Please enclose form if available)

Please send me information on Planned Giving.

Please add me to your Newsletter Mailing List.

This form may be printed off the website and faxed to:

UCP/NYC Online Gifts at (212) 951-7124

Or mailed to: Development Department, United Cerebral Palsy of New York City, 80 Maiden Lane, New York, NY 10038

Your gift is tax deductible to the full extent of the law.

Checks should be made payable to United Cerebral Palsy of NYC.

THANK YOU for your generous support!