Name

Company

Address

Address 2

City

State

Zip

Telephone

e-Mail Address

Individual Contributions

$50 Strong Kids Friend

$100 Strong Kids Friend

$250 Patron of Youth

$500 Youth Sponsor

$1,000 President’s Champion Round table

$2,500 President’s Round table Benefactor

$5,000 President’s Round table Founder

Other 

Business Contributions

$100 Strong Kids Business Friend

$500 Strong Kids Patron

$1,000 Strong Kids Sponsor

$2,500 Strong Kids Benefactor

$5,000 President’s Circle

$7,500 President’s Corporate Partner

Other 

I hereby authorize to be charged to the following credit card.

Credit Card Number

Expiration Date