Contribution Form

Please use this form to make your contribution to Kilimanjaro Guide Scholarship Foundation. The form is setup in four sections. Please complete all information. ** Required


	Personal Information

	Name: **
	Addres 1:
	Address 2:
	City:
	State:
	Zip Code:
	Country:
	Phone Number:
	Fax:
	Email: **


	Contribution Information

	Contribution Amount	$

		Contribution Method:			Paypal
					Check	Please mail to:
					Kilimanjaro Guide Scholarship Foundation
					15475 S. M-43 Highway
					Hickory Corners, Michigan
					49060 USA

	Would you like to be listed on our website as a supporter?
				Yes		No


	Mt. Kilimanjaro Experience

	Have you ever climbed Mt. Kilimanjaro?
					Yes		No

	If yes, then:
		Date climbed?:
		Company/Sponsor?


	Scholarship Nomination

	Do you want to nominate someone for a scholarship?				Yes		No

	If Yes then:

		Nominee's Name:
		Nominee's Climbing Company:
		Nominee's Address1:
		Nominee's Address2:
		Nominee's City:
		Nominee's State:
		Nominee's Zip:
		Nominee's Phone Number:
		Nominee's Fax:
		Nominee's Email:


	Notes

	If you wish to add notes or leave us a message, please use the provided space.


	Secutiry Answer **