________________________________________________________________________
Donation Form
AccessChicago – July 13, 2016
Navy Pier, Festival Hall A – Chicago, Il.
I would like to make a donation in the amount of:
$50.00
$75.00
$100.00
Other ___________Amount
I would like to make an In-Kind-Donation of:
Quantity Item Description
Estimated
Value
________________________________________________________________
Contact Person Information: (PLEASE PRINT CLEARLY)
Name__________________________________________________________
Company Name__________________________________________________
Telephone ___________________________Fax________________________
Email___________________________________________________________
Mailing Address___________________________________________________
Street Address
City
State
Zip Code
**Please return this form via mail, E-mail, or fax to the Mayor’s Office for People with
Disabilities, Attn: Fran Learnahan, Email: Frances.Learnahan@cityofchicago.org,
Fax: (312) 746-5786. We recommend that you keep a copy of this form for your records.
Check enclosed, payable to: City of Chicago
2102 W. Ogden, Chicago, IL. 60612
Attn: Finance Unit
Questions?
Call Fran Learnahan @ (312) 746-5768, 312-744-7833 (TTY)