Please complete the form below and send your check or money order, payable to "CFC" to:

Carole Warble
CFC Program Manager
8108 Eleanor Terrace
Baltimore, MD 21222

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Name: ____________________________________
Address: ____________________________________

Total Gift: $ ________

Recognition award: Yes _____ Declined ____

(You may designate specific recipients below)

Five-digit Agency Code ---- Amount

_______ ---------------- $ ______
_______ ---------------- $ ______
_______ ---------------- $ ______
_______ ---------------- $ ______
_______ ---------------- $ ______
_______ ---------------- $ ______


( ) You may release my address to agencies designated
( ) Do not release my address to agencies designated

Signature: _________________________ Date: _________

"Retired Federal employees may make single contributions to the CFC through check or money order. These non-Federal employees may not be solicited, but are to
be provided the opportunity to participate in the CFC." 5 Par 950 Code of Federal Regulations, November 24, 1995

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