Name of Donor:__________________________________________________________

Street Address:__________________________________________________________

City/Town: ______________________________________________________________

State:________________________________Zip Code:_______________-__________

Amount Inclosed $ ____________________


Please make checks payable to:

US Submarine Veterans' Charitable Foundation

Note in the memo portion of your check:   Scholarship Fund

Mail To:

USSV CF - Scholarship 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.

CFSF-1 (2002)