Lone Tree District - 2005 FOS Pledge Form

Yankee Clipper Council
Lonetree District
Friends of Scout Campaign
36 Amesbury Rd
Haverhill, MA 01830

Please fill out the form and choose either to be billed or payment is in the mail. You may print this form and send in with Payment. When you press the submit button this form is being sent to the Council Service Center.

Anyone pledging over $100 will receive a limited edition Council Patch with the word "Courteous" on it.

Name:
Billing Address:
City:
State:		Zip:
Telephone Home:		Telephone Work:
Email:
Pledge Amount:
Payment:	One Time : Monthly: Quarterly: Yearly:
Bill Me:	Payment in the Mail:
Does your Company have a matching gift program?: Yes No: