Gift= Form

It is my/our intention to help the Highland Area Community Foundation grow and prosper in its goal of providing grants for t= he Greater Highland Area. Enclos= ed is my/our gift of $_________________, to be used as follows:=

q = Apply $__________to the Sustaining Membership Program (Direct to Grants)
and enroll me at the appropriate level listed below:

$         1 - $         = 99.99        &= nbsp;           &nbs= p;         Topaz Level
$     100 - $       249.9= 9        &= nbsp;           &nbs= p;         Amethyst Level
$     250 - $       499.9= 9        &= nbsp;           &nbs= p;         Garnet Level
$     500 - $       999.9= 9        &= nbsp;           &nbs= p;         Opal Level
$ 1,000 - $    2,499.99 =             &nb= sp;            =     Sapphire Level
$ 2,500 - $    4,999.99 =             &nb= sp;            =     Ruby Level
$ 5,000 - $    9,999.99 =             &nb= sp;            =     Emerald Level
$ 10,000 &     Above            =             &nb= sp;       Diamond Level

q = Apply $__________to the Permanent Endowment Fund.

q = Apply $__________to ong= oing administrative support.

q= = Apply $__________to___________________________________________= __________________________

= &nb= sp; = &nb= sp; = &nb= sp; = (Please list a specific fund.)

In Memory of____________________________= __________________________________________________

In Honor of___________________________________ Occasion_____________________________________

&nbs= p;

The enclosed gift is from:

Address _____________________________________= ___________________________________________________________ ___________________________________________= _____________________________________________________________ ___________________________________________= _____________________________________________________________ <= /o:p>

City________________________ State/Zip___________________________ Telephone________________________________

&= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;

Please notify the following of this remembrance gift. (Amount of gift will not be disclosed.)=

Mr./Mrs./Ms./Miss___________________________________________= ____________________________________________ ___________________________________________= _____________________________________________________________ ___________________________________________= _____________________________________________________________ <= /o:p>

City________________________ State/Zip___________________________ Telephon= e________________________________

If you would like other information about the HA= CF, please call 654-4727, email at info@hacf.o= rg, or
visit our website at www.hacf.org=

The Highland Area Community Foundation is classi= fied as a tax-exempt organization under Section 501(c) (3) of the
Internal Revenue Code. Your gift may be deductible as a charitable
contribution to the extent permitted by the Internal Revenue Code.

Please make check payable to Highland Area Commu= nity Foundation and mail to
Highland Area Community Foundation, P.O. Box 571, Highland, IL 62249<= /b>