Name: _______________________________________________________

Phone: ____________________________ Date: ____________________

Email: _______________________________________________________
(Your information will not be sold or shared)

2010 Charity Calendar (Calendars will be distributed by the club)

    ____ $10.00 ea x qty: _______ = Subtotal $________

Have your special day printed on a square?

    (1)____ mm/dd/yy: ___________ occasion: _____________________________ $ 5.00 ea

    Text to print:______________________________________________________

    (2)____ mm/dd/yy: ___________ occasion: _____________________________ $ 5.00 ea

    Text to print:______________________________________________________

    (3)____ mm/dd/yy: ___________ occasion: _____________________________ $ 5.00 ea

    Text to print:______________________________________________________

    (4)____ mm/dd/yy: ___________ occasion: _____________________________ $ 5.00 ea

    Text to print:______________________________________________________

    (5)____ mm/dd/yy: ___________ occasion: _____________________________ $ 5.00 ea

    Text to print:______________________________________________________

Grand Total $_______

I used paypal - the paypal email address I used is: ___________________________________

Just fill out the application above and go to our paypal page and make a donation of the specified amount or mail a check (GCAM - P. O. Box 130192 - Houston, Tx 77219) to pay for it. Email the form to treasurer@gcam.org for completion of transaction. We will send an acknowledgement to the email address listed on the form. If you have any questions call 713 692-8735. Thank you for your order and your support.