Penny Pines Donation Report Form

Chairman: Terry Sampson, pennypines@cagardenclubs.org

Donor Name *

Organization Name

District (Scroll down to select)

Forest receiving donation *

Number of donations *

Amount enclosed *

In increments of $68.

Donation is

In Honor of
In Memory of

Provide the complete Name, Street or PO Box, City and Zip Code where certificate(s) is to be sent.

NOTE: If there are multiple entries, and you would like certificates for each individual, group, or family, have ALL certificates sent to one address for distribution.

Certificate mailed to: *

Your name *

Your email *

PRINT FORM (Print TWO copies before clicking on Submit. One to mail to US Forest Service office with check; one for your file.)

Please check with your local Forest Service office before mailing a donation.
One copy of the form is to accompany your check to the Forest Service; one is for your records. The electronic copy is to report donations to the CGCI Penny Pines Chairman
DO NOT MAIL CHECKS TO THE CGCI CHAIRMAN
ALL CHECKS ARE PAYABLE TO AND MAILED TO THE FOREST SERVICE OFFICE SELECTED