Your donation is greatly appreciated. Thank you for your supporting Brevillier Village Haven Program.

Amount of Donation:

$5.00

$________________________

Other Amount  

 *Please check the appropriate boxes above*

* Please print neatly when you fill out the form*

* Please use a black or blue ink only*

NAME:________________________________

ADDRESS:________________________________________

CITY:____________________     STATE:________________________    

ZIP:___________________

PHONE: (___)______________________

* This is a printable form*

Please make checks payable to:

Brevillier Village Recreational Haven Program

Check Donation

Cash Donation

Please check the appropriate boxes above*

  Please send your Donation To:

Marty Colliss - Director of Recreation

5416 East Lake Road

Erie, PA 16511

Phone:(814) 899-8600 Ext: 233

Monday- Friday

Your support is very much appreciated.

Thank you again for your Donation to our Haven Program.

If you have any more questions regarding the Haven Program.

Please contact the Recreation Director Marty Colliss or

e-mail her at MColliss@brevillier.org