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**Membership is granted with a donation of any amount. Support of any amount is
greatly appreciated.**
driveAWARE
A Traffic Safety Organization
Donation, Memorial and Honorary Gift Form
If you wish to contribute or make a memorial / honorary gift, please print and
complete this form.
Mail the completed form, along with your check or money order (no cash, please),
to:
driveAWARE
c/o Willow Grove Bank
2 North York Rd
Hatboro PA 19040-3201
Contributor's Name(s):_________________________________________
Address:_____________________________________________________
City:___________________________ State__________ Zip__________
Phone, Daytime & Evening: ( )_____________ ( ) ______________
Email address: _______________________________
Amount Enclosed: $__________
PLEASE COMPLETE ONE:
In Memory of:________________________________________________
In Honor of: _________________________________________________
Donation: _____________________________________________________
Sponsor: ___________________________________________________
Business/Corporation:________________________________________
Please let us know if you are (1) Victim or Survivor of a Traffic Safety event, (2)
Family member of a victim, (3) Person with a specific expertise in Traffic Safety,(4)
Concerned citizen. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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Would you like to work with a specific committee or interest area? _ _ _ _ _ _ _ _ _
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An acknowledgement will be sent.
We sincerely thank you for your support.
We are a non-profit corporation.
Please email any questions to: Ray Rauanheimo, Secretary/Treasurer (or call
215-674-0447)