DONATION REQUEST FORM

Name of KMA angel requesting donation: _______________________________________________

Name of family/individual needing the donation: __________________________________________________

       Address of the person in need: _____________________________________________________

       Briefly describe the situation involved in this request for donation:  ______________________________

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       How will the donation be used?____________________________________________________________

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       What is the Hardship or Immediate Need: ___________________________________________________

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      Dollar Amount Requested: $___________ Board Approved: ______ KMA Membership Approved: _____

      KMA Check #___________       Treasurer Posted Date: _______________