The Carl B. Kern Fund - Donor Form  

*** 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. ***

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   Business   Mobile
Your E-Mail Address:
Amount of Donation:$  
Would you like this donation 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:  
Please acknowledge this gift to (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?
(if form is printed, use other side if more space is needed):
Would you like these comments to be anonymous?: No     Yes
Please make your check payable to The Carl B. Kern Fund and mail both this completed form and your check to:
The Carl B. Kern Fund; c/o The Dayton Foundation; 40 N. Main Street, Suite 500; Dayton, Ohio 45423. Thank you very much!!