• Please provide the following information:

  First name
  Last name
  Title
  Company
  Street address
  Address (cont.)
  City
  State
  Zip
  Phone	Area Code	Number
  FAX	Area Code	Number
  E-mail

• I understand that unless I specify otherwise, 75%of my check will go to the scholarship fund and 25% to the charitable giving fund.

  Contribution	%
  Scholarship Fund
  Charitable Giving Fund

• I will send my check in the amount of $
  Contributions may be given in any amount. Special recognition will be given to those contributing, on an annual basis, in these amounts (Recognition also will be given for the cumulative value of gifts over time.
  

  120 Volt Club	$120 up to $276
  277 Volt Club	$277 up to $479
  480 Volt Club	$480 up to $999
  Kilowatt Club	$1,000 or more

Mail this form with a check payable to:
Electric League Foundation
PO Box 414168
Kansas City, MO 64141-4168

After the Form has been completed (and before you click on the "Send to the Electric League" button) print the form on your printer.