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Please print and use this form for contributions. If making a memorial gift honoring a friend or family member, a thank you card will be sent to them in your name.

Once completed, mail your check and this form to:
BCBA c/o
654D N. Wellwood Ave. # 181
Lindenhurst, New York 11757

Please accept my contribution of $___________

Please make all donations payable to: BCBA
Community Boxing Center Inc. is an ALL VOLUNTEER Non- Profit Corp.
501-C3 doing business as- BCBA | 11-373-1446

Your Name: ______________________________________________________________________________
Address: ________________________________________________________________________________
City: ________________________________________ State __________ Zip __________________________
E-mail Address: _________________________________________________________ (To be held in privacy)
|_____| My gift is in the name of another
In Memory of: ____________________________________________________________________________
In Honor of: ____________________________________________ for the occasion of ___________________

Please Notify :

Name ____________________________________________________________________________________

Address __________________________________________________________________________________
|___| I've enclosed a statement of sentiment and support. You have my permission to place them on your website.
...We thank you for your generosity...

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