The BACCHUS Network Donation Form

To make a donation, please print and complete this form, printing or typing all information.

Mail the completed form, along with your check or money order, to:

The BACCHUS Network
Hall of Fame
PO BOX 100430
Denver, CO 80250-0430

Contributor's Name(s)  
Address  
City  
State / Zip  
Phone Number (with area code)  
E-mail  
 
Please Complete as Applicable:
In honor of  
As a peer educator advisor  
As an alumnus peer educator, also please fill out questions A & B as well.  
A) Name of campus  
B) Year of participation  
 
Please pick a contribution level or write in another amount:
$25.00  
$50.00  
$100.00  
$250.00  
$500.00  
$1000.00  
Other amount (please specify)  

All contributions are tax deductible to the extent allowed by law.

Once your information is processed, you will receive a receipt for your donation.