NH Germanic Association Charitable Gift Record This form will be used to archive your gift to the NHGA.

Date:

Name:

Address: Street: Town: State: Country:

Telephone:

E-mail:

Amount of contribution or security contributed: _____________________________________________________________________

Would you like to have your e-mail address added to our Stammtisch and School announcement list?                                                  Yes  ____ No ____

Please send the completed form with your contribution to: NH Germanic Association 142 Wason Road    Hudson, NH 03051 Checks and securities transfers should be made out to the NH Germanic Association

The NHGA is a 501(c)3 (non-profit) public charity registered in the State of New Hampshire.  Gifts are deductible for Federal Income Tax purposes. Please save a copy of this document for your records.