DREAM PROGRAM Sponsorship and Donation Form Thank you for your interest in supporting the DREAM Program. Your donation will provide an athlete with varying abilities the opportunity to participate in a variety of recreational activities, while enhancing their quality of life and improving their independence. ☐ Yes, I/my business would like to sponsor _________ (enter number of athletes you would like to sponsor) Dream Program Athlete(s) for the 2015 program year. ($150.00 per athlete) ☐ I would like to make a general donation in the amount of: ___________________ to support the 2015 Dream Program activities. All donations and sponsorships are 100% tax-‐deductible Your First & Last Name OR Business Name: _______________________________________________________________ Address: ______________________________________________________________________________________________________ City, State, Zip: _______________________________________________________________________________________________ E-‐mail address: ______________________________________________________________________________________________ Phone: (_________)_____________________________________________________________________________________________ ☐ ☐ Enclosed is my check: Please make checks payable and send payment to: Dream Program PO BOX 2040 Gautier, MS 39553 Please charge my credit or debit card account using the information provided below: American Express MasterCard VISA (please circle one) Card Number: __________-‐___________-‐___________-‐___________ Exp. Date (mm/yy) ___________ 3 digit security code_________ Or make a donation directly on our website via PayPal: www.dreamprogram.net from the home page ☐ ☐ ☐ Please send more information on Dream Program offerings Please send information on upcoming Volunteer opportunities Please add me to your quarterly email Newsletter list For additional information, please contact Jodi Franke @ #228-‐202-‐1044