YES, I would like to make a contribution to help Optimist Youth Homes & Family Services.

INSTRUCTIONS:

Print this form Complete the information Mail this form with your check or money
order payable to: OYHFS 6957 N. Figueroa Street, Box 41-1076 Los Angeles, CA 90041-1076

Attention: Development Office or call Development Dept. (323) 443-3022 OR 877-74- YOUTH

I want my donation to help with:

r General Funds r Residential Services

r Optimist High School r Mental Health Services r Day Treament

r Independent Living r Community Group Homes

r Youth Learning Center r Foster Care & Adoption



Everychid Foundation Youth Learning Center - I"ll Walk With You"
r$250.00,Small Tile 6" by 6" - r$500.00, Large Tile 12" by 12"
(Inscription requested, please limit to 30 letters spaced in two lines )

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __


__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ 
 

Name__________________________________________________________________________ 

Address _______________________________________________________________________ 

City / State / Zip_________________________________________________________________

Telephone______________________________________________________________________
 
Email_________________________________Donation__________________________________ 

 Amount $_______________________________________ (U.S. Dollars) 

Payment: 
____Check ____Money Order ____MasterCard ____ VISA ____ American Express 


AccountNumber:_____________________________________________________________ 

Expiration Date: ___________________Security Code___________
 
Authorized Signature:_____________________________________________________________
 
I would like my donation to remain anonymous. Your donation to Optimist Youth 
Homes & Family Services is tax-deductible to the extent allowed by law.