Please check off the amount of your donation:

• HIGHFIELD CIRCLE  $2000 or more 

• $500 

• $250 

• $100 

• $50 

• $25

or

m I wish to make a special gift of $____________ in memory of 
__________________________________________________

m I am enclosing or will send a matching gift form from my
my company _____________________________________

Name: ____________________________________________

Address: ___________________________________________

City: ____________________ State: ______ Zip: __________

Telephone: __________________________________________

Email (Optional): ____________________________________