Boulder Community School of Integrated Studies

Suggested donation is $200 per child per school year, but please give 
what you can--more or less than this amount is much appreciated, too!

Name: ________________________________________________  Phone: ___________

Child(ren)'s Name, Grade, Teacher:  ______________________________________

__________________________________________________________________________

Address (+City & Zip):	__________________________________________________

__________________________________________________________________________

_____  Enclosed is cash or check to BCSIS in the amount of $ _____________


_____  Enclosed are my _________ (how many?) post-dated checks in the 

       amount of  $______________ each.


_____  Please charge my donation to:  ___ Visa      ___ MasterCard	

       One-time charge of $______________,  OR
 
       2 (two) semester charges (September 06 and February 07) 

         of $ _______________ each

       8 (eight) monthly charges (September 06 through April 07) 

         of $ _______________ each 

       Card Number: ______________________________________________________________

       Expiration Date:	________________  


_____  I would like a sponsor. (All identifying information will remain confidential.)

Thank you for supporting BCSIS.	All contributions are tax-deductible.