OTA
DEVELOPMENT FUND CONTRIBUTION
Omaha Special Olympics Tennis Activities
| Last Name ___________________ | First Name _________________ | Date ______________________ |
| e-mail ______________________ | Spouse____________________ | |
| Address | City ________________________ | State/Zip+4 ____________-________ |
| Home Phone ( ) | Work Phone ( ) | Spouse's Work Phone ( ) |
| Other Contact Phone Numbers ( ) ( ) | ||
| _____ Donation | Up to $34 | $ _______ |
| _____ * Club Contributor | $35 - $84 | $ _______ |
| _____ * Champion Benefactor | $85 - $164 | $ _______ |
| _____ * Professional Patron | $165 & Over | $ _______ |
* Designation listed in OTA Roster Book
Return
this form with your contribution to:
Omaha Tennis Association
PO Box 8313
Omaha, NE 68108-0313
Checks payable to OTA Development Fund. Total Amount Enclosed $ __________
Please use my Development Fund donation for: _____ Omaha Special Olympics Tennis Activities