Yes, I'd like to become a monthly Mountain Sponsor!

Here's My Monthly contribution of: (Please check one)
$10.00 _____    $15.00______   $25.00_____   Other $_______

Date of Withdrawal (check one):   1st of the month_____   15th of the month_____

Bank:______________________________________ Branch:_________________________________________

PLEASE ATTACH A VOIDED CHECK

Your Name(s)__________________________________________________
Address_____________________________________________ Phone___________

Your Signature(s):____________________________________________________________________________

I (We) authorize the Charitable Partnership Fund (CPF) to initiate debit entries to my (our) account described on this form, at the Bank indentified on this form, and to debit the same to such account. This authority will will remain in effect until I notify CPF in writing to cancel it, in such time as to allow the Bank a reasonable time to act on the termination.

I can stop payments of an entry by notifying my financial institution three (3) days before my account is charged. I may also change the amount fo the debit by notifying CPF in writing. The Charitable Partnership Fund may be reached at: PO Box 13276, Portland, OR 97213-3276

Such Debits are to be made for the Benefit of the Non-Profit Organization Identified on this Form, hereinafter called Recipiant, to be paid to Recipiant in the manner and times as agreed between CPF and Recipient.

I (We) understand that if the Recipient is not qualified as a public charity, or otherwise does not satisfy the distribution policies set forth by CPF, I (We) may identify another organization to serve as Recipiant . I (We) further undrstand that CPF has final authority over the entity that may serve as Recipiant, as set forth in CPF's policies.

Please print out this form with your browser's print function and mail to:

Friends of Buford Park & Mt. Pisgah
PO Box 5266
Eugene, OR    97405