Please send completed form to:
HOLY NAME CENTRAL CATHOLIC JUNIOR/SENIOR HIGH SCHOOL
144 GRANITE STREET
WORCESTER, MA 01604
(508)-752-2981 FAX (508)-831-1287
We are happy to make a contribution to the Annual Fund
| | $200 | | $175 | | $150 | | $125 | | $100 | | $75 | | $50 | | $35 | | Other $______ |
| | I have enclosed a second donation for the Athletic Field Appeal $ _________ |
| (We are close to our goal. Please help push us over the top.) |
| | Founders ($2,500 or more) $ ________ |
| | Benefactors ($1,000 to $2,499) $ _________ |
| | Mother Marie Anne Society ($500 to $999) $________ |
| | Headmaster's Council ($250 to $ 499) $__________ |
| | Please use my gift for the Unrestricted Gift Account, or |
| Use my gift towards |
| | Education Programs |
| | Buildings and Grounds |
| | Tuition Assistance |
| | Junior High School |
| | Computer Technology |
| | The Arts Department (music, theater, art) |
| | Endowment |
| | Other ____________________________ |
| | This is a joint gift with: ____________________________________ |
| | This gift will be matched by: ____________________________________ (company name) *** See Below |
| | I have enclosed a matching gift form |
| | Check made payable to HOLY NAME C.C. JR/SR H.S. is enclosed $__________________ |
| | Charge card $ ____________ |
| | VISA |
| | MASTERCARD |
| ACCOUNT NUMBER______________________________ EXP. DATE: ________________ |
***Your gift could be doubled or tripled if you and/or your spouse work for a company that offers a Matching Gift Program. Please check with your company's Human Resource Department to obtain necessary forms. Contact Mr. Paul Lavallee @ 508-753-6371 () for a list of companies that offer matching gifts.