Print this form and mail to the address below.

All gifts are 100% tax-deductible.

I Wish To Support
The Cody Blue Foundation

Enclosed is my tax-deductible gift of $___________ for the Cody Blue Foundation..

Name     ________________________________________________________

Address ________________________________________________________

_______________________________________________________________

Phone __________________________________________________________

I wish to make my gift

[ ] Donation In Memory Of _________________________________________________

[ ] Donation In Honor Of ___________________________________________________

[ ] Deceased's Name _____________________________________________________

[ ] Where to send acknowledgement __________________________________________
______________________________________________________________________

Please acknowledge my gift

[   ] To the Same address as above

or to

Name ___________________________________________________________

Address _________________________________________________________

Phone____________________________

Please make checks payable to:

Cody Blue Foundation

PO Box 70

Grifton, NC 28530