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Grain for Grandparents
Rock River Center, Inc.
Name_______________________________________________________________
(Print name as you wish it to appear in donation recognition)
Address______________________________________________________________
City_______________________________ State
_________Zip_________________
E-mail___________________________________ Home Phone________________
______________________________________________________
In support of Rock River Center’s Capital Campaign
I /We wish to contribute a Gift of Grain: _______bushels of #2 yellow dry corn. This gift will be donated from the ______ harvest. It is understood that upon delivery, said grain becomes the property of and will be sold by the Rock River Center.
I prefer to donate Soybeans ___________bushels, from ________harvest.
Elevator or cooperative to be delivered to _______________________________
I/We give this gift in memory or honor of (circle choice):
I/We wish this donation to remain anonymous. Yes____ No_____
With my/our signature below, I/we understand that this pledge will be counted toward the campaign goal.
Please return this form to Rock River Center, 810 S 10th St., Oregon, Illinois 61061. For more information, please contact Ann or Karen at 815-732-3252.
Rock River Center, Inc. is a not for profit, private 501 c (3) organization. Gifts are tax deductible as permissible by law.
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