Pledge Form

CCPA Annual Season Fund Drive

Thank you for your tax-deductible donation.

Donation Form

Mail to :  CCPA, P.O. Box 754, Nevada, MO 64772

Executive Producer: $1000+

Producer: $500 – $999

Associate Producer: $100 – $499

Patron: $20 – 99

I would like to donate $ ________________ .  My check payable to CCPA is enclosed.

NameAddress

City

State

Email

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Is this gift in honor or memory of someone?   ____________________________________________