Street Address:_________________________________________________________

City/Town: ______________________________________________________________

State:________________________________ Zip Code:_______________-__________

Amount Inclosed $ ____________________

Please make checks payable to:  US Submarine Veterans' Charitable Foundation
In the memo portion of the check:    Frederickson Family Fund

Mail To:

USSVCF- Brotherhood Funds
P.O. BOX 3870
Silverdale, WA 98383-3870

Please include this form with your donation.

Thank you for your interest and support of this program.

CFBF-1 (2003)