YES!  I would like to see a “Beauty & the Beast Bench” in Central Park become a reality.  Enclosed is my tax deductible donation of: 

 

$25____     $50_____   $75____  $100_____  Other $_______

 

 NAME: _________________________________________________

 

ADDRESS: ______________________________________________

 

________________________________________________________

 

_________________________________________________________

 

TELEPHONE #: ___________________________________________

 

E-MAIL ADDRESS: ________________________________________

 

Please tell us what you would like to see as the inscription on the plaque.  There is available space on the plaque for 4 lines of 40 characters per line:

 

  

PLEASE NOTE:  The best submissions will be selected from among all received and voted on to choose the plaque inscription.  All submissions are welcome, however, only those who contribute a donation will be contacted for the final voting.  (In the event that there is not enough response to reach our goal, donations will be returned.)

 

 Please return this form to:

Rosemarie Salvatore, 905 Broad Street, Apt. F-12, Bloomfield, NJ 07003

E-mail: Radcliffe052002@yahoo.com