Burns Park Foreign Language Initiative: Pledge Form

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2201 Brockman Blvd., Ann Arbor MI 48104 (734) 994-8553

BPFLI Pledge Form

Yes!! I want to support this high-quality enrichment program at Burns Park Elementary!

To contribute now by credit card, please use our convenient credit card payment system on the contribution page.

To contribute by check, please print out a copy of our contribution form to return with your check.

To make an online pledge, please fill out the following form:

Name:
Address:
City:	State: Zipcode:
Telephone:	Email:

I would like to pledge (choose one):

At a sustaining level of $1,000 $500 or $ (please specify)
$100 to cover one year of intensive instruction for my own child.	$200 to cover one year of intensive instruction for two children.
$300 to cover one year of intensive instruction for three children.	$35 to cover once-weekly instruction for one child.
Other amount of $ (please specify)

Please indicate how you wish to schedule your pledge payments:
I will fulfill my pledge with a single payment made on or before (Please indicate date.)	I would like to fulfill my pledge over time with two or more payments (please indicate schedule):

My employer will match my contrubution.

I wish my donation to be anonymous.

Please keep me updated about the Spanish language program by email.

BPFLI is a 501(c)(3) public charity, and all donations are tax deductible to the full extent of the law.

Your contact information will only be used to handle your pledge and contribution, unless you have also requested that we send you program updates by email. Personal information will not be used for any other purposes and will not be released to any other organization.

Burns Park Foreign Language Initiative
2201 Brockman Blvd.
Ann Arbor, Michigan 48104
Contact: Helen Starman (734) 994-8553