Printable Donation Form

If you’d like to mail or fax a donation, please print this printer-friendly version of our form and mail or fax the form to:

The Fresh Air Fund
633 Third Avenue, 14th Floor
New York, NY 10017
Fax:   212-681-0146

Donation

____ $25 ____ $50 ____$100 ____ $250 ____ $500____ Other: ____________

Name: _____________________________________________________

Address: ____________________________________________________

___________________________________________________________

City: __________________________

State/Province: ________ Zip: ____________

E-mail: ______________________________________

Please make your check or money order payable to The Fresh Air Fund.  For credit card donations, please provide this additional information:

Name (as it appears on card): ___________________________________

Credit Card Number: __________________________________________

Expiration Date: __________ (MM/YY)

Credit Card (circle one):  MasterCard  |  VISA  |  American Express

Signature: __________________________________________________