Photo of C.B. Kern THE CARL B. KERN FUND
of The Dayton Foundation

established 1987

40 N. Main Street, Suite 500   *   Dayton, OH 45423
(937) 222-0410   *   (877) 222-0410   *   FAX: (937) 222-0636

Looking for the former Friends of Kern, Inc. site? Click here to launch in new window.

Dayton Foundation Logo
 
The Carl B. Kern Fund - Donor Form
[printable version]  

*** SPECIAL ANNOUNCEMENT - To celebrate the Fund's 30 Years, all donations currently received - excluding estate gifts - will be MATCHED by the Fund's founder up to a total of $30,000. ***
Although online payments cannot be made through this form, we ask that you complete the following information so that your donation can be appropriately documented and recorded.

Click the Confirm Donation Button button at the bottom to produce a summary of your information that you can confirm, print and mail with your donation. THANK YOU!


Your Name:
Street Address, Line 1:
Street Address, Line 2, if any:
City, State/Province, Zip/Postal Code:
Preferred Phone Number, with Area Code:   Home   Bus.   Mobile
Your E-Mail Address:
Amount of Donation:$  
Would you like this gift to be anonymous?: No     Yes
If no, please list how name(s) should appear:

Please complete the information below if you would like this to be an honorary or memorial gift, which will be recognized online. You can also acknowledge this gift to individual(s) you specify plus add any comments on why you want to recognize this person. Those comments will be compiled and linked to the person's name.

This Donation is in Honor  Memory of: Name(s):  
Please acknowledge this gift to:
  (Please enter name and address. If
  you don't know the address, we'll try
  to find it - just give us a few hints!)
Any comments on why you are
recognizing this person/these people?
  (If form is printed, use other side
  if more space is needed):
Would you like these comments to be anonymous?: No     Yes