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If you are interested in contributing to the Rape Crisis Center in any way, we want to hear from you.
 

RAPE CRISIS CENTER
DONATION FORM

Administration Phone Number 608-251-5126 Crisis Line/Services 608-251-7273
 
Please fill out this form and send your contribution to: Office Manager, Rape Crisis Center, 128 E. Olin Avenue, Suite. 202, Madison, WI., 53713.
 
NAME:___________________________________ DATE:______________
 
STREET ADDRESS:_____________________________________________
 
CITY:______________________________STATE:___ ZIP:____________
 
PHONES: home)__________________ work)__________________
 
EMAIL:________________________________________________
 
checkboxPlease do not include my name in the Annual Report.
 
Personal Donation
 
checkbox$30-49   checkbox$50-99   checkbox$100-249   checkbox$250-499
checkbox$500 & Up   checkbox$__________Fill in Amount
 
checkboxIn order to allow more funds for services, please do not send me an acknowledgement.
 
Organization / Business Donation
 
checkbox$100-249   checkbox$250-499   checkbox$500 & Up   checkbox$__________Fill in Amount
 
Volunteering
 
checkboxI'd like more information about volunteering.