2015-2016-SERC-Chapter-Donation

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SERC Chapter Donation Form
2015 -2016
Date Mailed: _______________________
Chapter Name: ________________________________ Chapter #_____________
State: _____________________________
Treasurer’s Name: ___________________________________________________
Address: ___________________________________________________________
___________________________________________________________
Treasurer’s Email Address: ____________________________________________
Amount of Donation: ________________
Please mail donation to:
Gail Marchant, SERC Treasurer
6960 Cowan Mill Rd.,
Winston, GA 30187
Home: 770-949-4658
Cell: 770-846-1187
Email: [email protected]
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For Completion by the SERC Treasurer
Date Received: _______________________ Check #_______________________
Date Deposited: _________________ Date sent confirmation: _______________
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