To make contributions please print this form, fill it out and mail to Scout Service Center.
A donation may be made to the Great Rivers Council Tribute/Memorial fund in memory of a loved one, in honor of a friend, associate, or relative or simply to thank someone.

Donor(s) name and address:

________________________________________________________________________
Your Name                Address                     City                          

________________________________________________________________________

State                     Zip

Donation is to be made in honor or memory of:

Recipients Name _________________________________________________

Reason for donation: deceased, anniversary, birthday, sick, job well done, thanks, congratulations, other (please circle one)?  Please use reverse side to give details.

To whom would like an acknowledgment letter sent?

________________________________________________________________________
Name                Address                     City                          

________________________________________________________________________

State                     Zip

And what relation is this person to the donor(s)? _______________________

Amount of donation _______________      Check or Money Order Number ___________
Cash? Yes / No (Not recommended to send cash through the mail).
Your name will be included in the acknowledgment letter and The Pilot  BUT not the amount of your donation.

Mastercard, Visa or Discover _________________________________________________

Expiration Date:_____________ Signature: _____________________________________