Annual Gift
Please complete the information on this form, print,
and mail with your contribution.


Name:
Address:
City: State: Zipcode:
Phone: () - ext. Home Business

This Gift is being made in memory of:


Please Acknowledge:
Name:
Address:
City: State: Zipcode:

Amount of Gift $
Cash or Check Enclosed (Please make checks payable to Al Sigl Center)
Credit Card (Visa/MasterCard/American Express) Charge $
Card # Exp. Date

Signature:________________________________________________________
My company will match my contribution.



Please make checks payable to Al Sigl Center . To expedite gifts of securities, please call Karen Gaffney at 442-4100, ext. 8980 or email k_gaffney@alsiglcenter.org Mail to: Al Sigl Center, Inc., 1000 Elmwood Avenue, Suite 300, Rochester, NY 14620-3098