Donor Name:*

Phone Number:*

Donor's Address:*

Donor's City:*

Donor's State:*

Donor's Zip Code:*

I would like this gift to honor the following individual:

Designation:

Birthday
Anniversary
In Memory

Other:

Please send acknowledgement to:

Address:

City:

State:

Zip Code:

Tax Deductible Gift:

$27 to sponsor 1 child for a year
$54 to sponsor 2 children for a year

Amount other than $27 or $54:

OR Primary Sponsorship of:

$500 Imagination Library Friend
$1,000 Imagination Library Key Financial Partner