My name

My name: __________________________________________________________________________________ Email: _____________________________________________ Phone: _________________________________ Name of special child/children: _____________________________________________________________ My greeting should read: ___________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ I would like to purchase _____ Love Notes at $30 each for a total of $ __________. I would like to make a cash donation to the Scholarship Fund of $ _____________. We accept checks (payable to Beauvoir Scholarship Auction) Visa/MasterCard. Card# (Visa/Mastercard): ___________________________ Expiration: _____ Security Code: _____ Name on Card: _________________________________________________________________________ Authorized Signature: ____________________________________________________________________ Please return this form with payment and attachments by: February 21, 2017 Beauvoir Scholarship Auction 3500 Woodley Road, NW, Washington, D.C. 20016 Phone: 202.537.6513 TAX ID# 8661-14717-01

Fax: 202.537.6512 Email: [email protected] Please keep a copy of this form as an initial receipt.