Contribution Form

MY COMPANY /I WOULD LIKE TO HELP DYSLEXIA TUTORING PROGRAM IN ITS IMPORTANT WORK OF SCREENING, TUTORING AND SUPPORTING PEOPLE WITH DYSLEXIA IN MARYLAND

	NAME:___________________________________                                      

	COMPANY:________________________________    	                                  

	ADDRESS:________________________________                                       
	
		________________________________                                     

	PHONE : ________________________________

CONTRIBUTION OR PLEDGE AMOUNT:

PLEASE MAKE CHECKS PAYABLE TO: Dyslexia Tutoring Program AND MAIL WITH THIS FORM TO:

Dyslexia Tutoring Program
711 W. 40th Street, #310
Baltimore, MD 21211

THANK YOU FOR YOUR TAX-DEDUCTIBLE DONATION.