Leadership Cares Foundation Contribution Form

Name        ______________________________________________________

Address    ______________________________________________________

City          ________________        State   ___________    

Zip   __________

Phone    (____)________     Fax    (____)_________

E-mail        ____________________________________________

Check the Program or Programs that you would like to contribute to:

_____ MentorCares Program

_____ LiteracyCares Program

_____ Annual Thanksgiving Basket Program

Check____ Credit Card_____ Mastercard____ VISA____ Am.Exp.____

Credit Card #________________________________________________

Expiration Date____________________________

Donation Amount____________________________________

Signature__________________________________________

Please fax this completed form to:

Leadership Cares
301-253-4233

or mail it to:

Leadership Cares Foundation
10181 Nightingale Street
Gaithersburg MD 20882