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Miami Valley Science and Engineering Fair

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					                       Miami Valley Science and Engineering Fair
                              West District Science Day

                                      Central State University

                         General Contribution Information Form
Funds will be used for operating expenses for the science fair like rentals, supplies and food.
For a list to sponsor a specific need, or for an information packet, contact the Fair Director.

   1. Sponsor/Organization’s

       Name:_________________________________________

   2. Address:

       __________________________________________________________

   3. Contact

       Person:___________________________Phone:____________________

   4. Contact Person E-mail address:_______________________________________

                      Please choose which level you will contribute to:

_______ Bronze            up to       $199

_______Silver          $200       -   $499

_______Gold             $500 -        $999

_______ Platinum        $1000 - $1999

_______ Einsteinium $2000 and above

                          Please enclose a check made out to
                Central State University Foundation – Miami Valley SEF

                                             and mail to:

                                  Dr. Cadance Lowell
                  Director Miami Valley Science and Engineering Fair
                               Central State University
                           PO Box 1004, 1400 Brush Row Rd.
                                Wilberforce, OH 45384

        For more information call: (937) 376-6274 clowell@centralstate.edu

				
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posted:10/2/2011
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