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SPECIAL OLYMPICS
 WESTMORELAND COUNTY
 CYCLING PROGRAM
DONOR FORM
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Yes, I want to help provide cycling training and competitions to persons with intellectual disabilities.  Please accept the enclosed donation from:

Donor Name   

 		______________________________________________

Address

 		______________________________________________

City, State, Zip Code     

 		______________________________________________

Telephone #   

 		______________________________

Web Site Address

 ______________________________
(All donors with web sites can choose to have a direct link from www.westspol.org)

Cash Donation Amount $____________     

 

Yes, we would like to make the below listed In-Kind Service donation.
(A Special Olympics-Westmoreland County representative will contact the donor)

________________________________________________________________________ 
________________________________________________________________________
________________________________________________________________________

Do not send cash. Please make checks payable to: 

Special Olympics-Westmoreland County


Complete and Mail to:

Thank you!

Special Olympics-Westmoreland County
PO Box 547
Greensburg, PA   15601


The official registration and financial information of Special Olympics Pennsylvania, Inc. may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.