Please accept my donation as indicated below.

__________ $100.00            ___________ $200.00

Important information we need:

Contact Name: _______________________________________________________________________

Company Name: ______________________________________________________________________

Address: ____________________________________________________________________________

Phone: ______________________________________________________________________________

Fax: ________________________________________________________________________________

E-mail: ______________________________________________________________________________

Total amount you would like to sponsor!_____________________________________________________

Thank you!!!!!

Lebanon-Marion County Chamber of Commerce

239 N. Spalding Ave. Suite 201

Lebanon, Kentucky,40033-1518

Phone: 270-692-9594

Fax: 270-692-2661