Glen Cove InterAgency Council Contribution Form

Our member agencies rely on contributions of supporters like you. Your contribution to the InterAgency Council is used to help us help others by supporting a wide range of community services and activities and we thank you! Contributions are tax deductable to the full extent permitted by law.

Please print this form to make donations by mail.

Date:

Name:

Company:

Address:

Address 2:

City, State, Zip:

Phone:

Phone 2:

Email:

Amount:

Please let us know how you would like to apply your donation.

To the InterAgency Council of Glen Cove as a whole.

For these InterAgency Council Member agencies/services:

Please make your check payable to the Glen Cove Youth Board and mail to

Glen Cove InterAgency Council
Glen Cove City Hall
Glen Cove NY 11542

Signature ____________________________________________________