National Charity League,Inc Mothers and Daughters Serving Communities Together First Name* Middle Name Last Name* Address* City* State* Zip* Telephone* Your Email* Check here to confirm the address above is where you would like your tax letter sent. Please write on the line below the donor name as you would like it to appear in the Charity Ball program. Please complete your donation by November 1st if you would like to be included in the program. formal names* Please include formal names on the line above, including middle names. For example, please write “Mr. and Mrs. James Adam Smith” or “Miss Maria Anne Brown” Presenting Debutante Please include me as a contributor at this level of giving: (If you would like program recognition for more than one Presenting Debutante in the Charity Ball Program, please complete a separate Form for each Presenting Debutante OR please select "The Entire Presenting Class" in the drop down menu below") 10,000 Ruby – Includes 10 tickets to the Charity Ball 5,000 Sapphire - Includes 5 tickets to the Charity Ball 2,000 Gold – Includes 2 tickets to the Charity Ball 1,000 Silver – Includes 1 ticket to the Charity Ball 500 Benefactor 250 Patron 100 Supporter Enter Amount (if different than amounts listed above) Please Select 2018 Presenting Debutante Member from Drop-down Menu The Entire Presenting Class of 2018Miss Felicity Annabelle BlackMiss Jacqueline Mary BruderMiss Mia Meicai DawsonMiss Jordyn Taylor FardadMiss Persia Brooke Fardad-FinnMiss Isabella Francesca GettingsMiss Carley Jordan GoldfarbMiss Taylor Rae GorjestaniMiss Melissa Anne KernMiss Cami Jade KleinMiss Emma Lyla MumfordMiss Nicole Michelle NaidrichMiss Alexandra Marie PatiernoMiss Neala Ariel RashidfarrukhiMiss Jordan Simone RobinsonMiss Nicole Joy Alexandra McGinnisMiss Brooke Ashley WayneMiss Caroline Helene Zaelke Post Debutante ($50 donation per Post Debutante) For Post Debutante recognition, please check the box and complete the Post Debutante information next to each debutante including their maiden name and their married name if applicable. Post Debutante Honoree: Married Name: year presented: Donated amount: Post Debutante Honoree: Married Name: year presented: Donated amount: Post Debutante Honoree: Married Name: year presented: Donated amount: Post Debutante Honoree: Married Name: year presented: Donated amount: Total Donation Amount Employer Matching My Employer has a Matching Funds Program or Foundation Your donation is tax-deductible to the full extent allowed by law. Your generosity and support are greatly appreciated. Please contact Jill Ortiz at 818-482-4858 if you have any questions about completing this form. In addition to the thousands of hands-on volunteer service hours our members donate to philanthropies on an annual basis, the San Fernando Valley Chapter has also proudly provided over $3 million in financial assistance since 1969 to Ability First, New Horizons, Guide Dogs of America, ONEgeneration, West Valley Food Pantry and, on a special needs basis, to our other sponsored philanthropies.