*In order to make a donation, print this form by clicking the print button below
and mail it in with your donation*

	I wish to benefit the quality of life in our community for young men and women with Diabetes through the enclosed donation of:
Patron $5,000 and over     Sustainer $1,000 to $4,999     Provider $500 to $999     Friend $250 to $499 Associate $100 to $249 Contributor up to $99
Name (as it should appear in Foundation listings): _______________________________________________ Address: ________________________________________________________________________________ City: ______________________State:____________Zip: _________Phone: __________________________ My gift should be used for the Aimee Melissa Davis Memorial Scholarship Fund Please acknowledge this gift to: Mr. David M. Davis 2133 Melridge Pl. Austin, Texas 78704 and Mrs. Sue K. Norris 5403 Scout Island Circle South Austin, Texas 78731 Mail your donation to: Austin Community Foundation; P. O. Box 5159; Austin, TX 78763

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