Name of Donor: __________________________________________________________

Street Address:___________________________________________________________

City/Town: ________________________________________________________________

State:________________________________ Zip Code:_______________-____________

Name of Person to be memorialized: _________________________________________

Please attach a Biography of this person to be included with the fund data.

Amount Inclosed $ ____________________ (Minimum $1,000.00)

Please make checks payable to:

US Submarine Veterans' Charitable Foundation

In the memo portion of the check:

Individual Memorial Scholarship

Mail To:

USSVCF- Scholarship Endowment Fund
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.

CFIMSEF-1 (2002)