for

MEDICAL, YOUTH, AND CHILD CARE SERVICES

As an individual that cares about the well being of families and the economic progress of Northeast Spokane, we pledge our support for the expansion of medical access, youth programs including young teens, child care services and other programs at the Northeast Community Center and to the physical facility expansion that will make this possible.

Please accept my pledge of $______________ annually for each of the next three years.

Payments Options:

____ Check enclosed

____ Bill me annually

____ Charge my credit card ____ In a lump sum or $____ per month

___Visa ___ Master card Card Number ________________________ Exp. _____________

Signature _______________________________________ Date _______________

Supporter __________________________ Phone _______________________

Address ______________________________________________________________

City _______________________ State _____ Zip ___________________________

Signature:___________________________________________Date______________

____ My employer has a matching donation program

Company Name ______________________________________________________________

RETURN TO: Expansion Project

Northeast Community Center Association

4001 N. Cook

Spokane, WA 99207