Street Address:

City: State:

Zip:

Phone (Home): (Business)

Fax: E-mail:

I want to help build the dream (Check any that Apply)

Place me on your mailing list and send me newsletter!
I/We Pledge a total of $ towards the Filipino Community
Center Inc. payable as indicated:

annual payments of $

quarterly payments of $

monthly payments of $

payments as follows: $

My/Our tax-deductible gift will begin: