First Name:

Last Name:

Home Address:

City:

State:

Zip:

Telephone:

include extension; e.g. 734-785-7705 x 7152

Fax:

Email:

I have mailed my check to Maryanne Adams in the Development Department for the amount below:

Amount:

$

(enter amount with decimal (e.g. 100.00))

Please make check payable to: THE GUIDANCE CENTER

Gift Designation:

Greatest Need (support all underfunded programs) Kids-TALK Let's Talk Workforce Development Family Resource Center Developmental Disabilities Other Program

Other Program Designation:

if you chose "Other Program" above, please indicate program name here:

Your Gift Choice:

Please refer to the chart at the right for gift eligibility.

If you are eligible to receive a gift, choose from the following:

Choose One TGC T-Shirt TGC Polo Shirt TGC Tote Bag

If you chose a T-Shirt or Polo Shirt, please indicate preferred size below:

Choose One Large X-Large XX-Large

Any other instructions or comments: