_____Yes, I would like to contribute $______.  (check enclosed) or donate  

                by PayPal  (button on right)

_____Yes, I would be available after Rebuilding Day to serve as part of the  

                   pickup team

____Yes, I would like to participate year-round. 

                Please call me.

_____Yes, I wish to contribute $_________ to help my neighbors remain

                warm safe and dry in their homes. 

_____Yes, I would like to contribute the following materials/supplies:

__________________________________________________________________

Name:____________________Group___________ Email____________________

P.O. Box___________City/Zip:___________________Phone_________________

(Rebuilding Together is a 501 (c)(3) non-profit organization which repairs the homes of low-income older adults, individuals living with disabilities and families with children.  We rely on donations of time and money from within the community.) 

 Thank you for your support!!!

Print this form, fill it out and mail to:

Rebuilding Together Mountain Communities

P.O. Box 3540, Blue Jay CA 92317                                              

(909) 336-3910

Email: rebuildingtogethermc@netscape.com