Membership Contribution Form

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Name(s): _______________________________________________

Street: ________________________________

Town:_____________________ State: ______________ Zip ________

Membership Types: Individual $25; Family $50; Business/Professional $100

Amount of Contribution: $ ___________

Membership contributions are placed in our Unrestricted Fund. You may add to your membership contribution and elect one or more of our permanent funds to receive a gift. Please indicate below which fund(s) you would like a percentage of your extra gift to go.

The Unrestricted Fund _____ %

The General Endowment Fund _____ %

The Founder's Fund _____ %

The Katie Battison Memorial Scholarship Fund _____ %

The Madison Beach Club Endowment Fund _____ %

The Senior Council Fund _____ %

The Madison Fund _____ %

The Athletic Excellence Fund ____ %

Thank you. Please mail to The Madison Foundation, Inc. P.O. Box 446, Madison, CT 06443, with your check.

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