Mary J. Szczepanski "Never Give Up" Ms Scholarship Sponsor Tracking Sheet
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2Mary J. Szczepanski “Never Give Up” MS Scholarship
Sponsor Tracking Sheet
Enter information for all offline contributions you collect. Photocopy this sheet as needed.
Please make all checks payable to: Accelerated Cure Project for Multiple Sclerosis
Student Name: ____________________________________________
High School: ______________________________________________
Name:
Street Address:
City, State and Zip Code:
Email Address:
Phone Number:
Donation amount:
Send Tax Receipt [ ]
Sign up for Accelerated Cure Project’s Mailing List [ ]
Name:
Street Address:
City, State and Zip Code:
Email Address:
Phone Number:
Donation amount:
Send Tax Receipt [ ]
Sign up for Accelerated Cure Project’s Mailing List [ ]
Name:
Street Address:
City, State and Zip Code:
Email Address:
Phone Number:
Donation amount:
Send Tax Receipt [ ]
Sign up for Accelerated Cure Project’s Mailing List [ ]
Name:
Street Address:
City, State and Zip Code:
Email Address:
Phone Number:
Donation amount:
Send Tax Receipt [ ]
Sign up for Accelerated Cure Project’s Mailing List [ ]
Name:
Street Address:
City, State and Zip Code:
Email Address:
Phone Number:
Donation amount:
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