PENNSYLVANIA DIETETIC ASSOCIATION FOUNDATION SCHOLARSHIP PARTNERSHIPS

Contribution Level:
_____ Gold ($2,000-$2,900)    _____ Bronze ($500-$599)
_____ Silver ($1,000-$1,999)    _____ Friends of the Foundation ($100-$499)

Designation of Scholarship Recipient

_____ Billye June Eichelburger
_____ Sara Clemen Parks Fund
_____ Shared Equally

 

Name of Company:__________________________________________________

Contact person:____________________________________Title_____________

Address:___________________________________________________________

Phone number:__________________________________________

Fax number: ___________________________________________

Email address:__________________________________________

 

Tax Deductible Contribution: make checks payable to:

Pennsylvania Dietetic Association Foundation
P.O. Box 60870
Harrisburg, PA 17106-070