Friends of Kern, Inc.

Friends of Kern, Inc. Established 2002 www.friendsofkern.org
A non-profit charitable 501(c)(3) tax-exempt organization dedicated to maintaining contact with friends and alumni of YMCA Camp Kern, preserving Camp Ozone & Camp Kern's history, and perpetuating the camp experience and life's work of former Boys' Secretary Carl B. Kern.

DONATIONS FORM

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Fields in RED are required.

NAME &
BIRTHDATE

Name: (as it should appear on listings)
(To Confirm ID) Birthdate: (year optional!)	MM: DD: YYYY:

CONTACT
INFO

Preferred E-Mail Address:
Which Email Address is This?:	Home Work
Preferred Phone No., w/ Area Code:
Which Phone Number is This?:	Home Work Cell

MAILING
ADDRESS
TO SEND
THANKS

If a Business Address, Name of Business:
Street Address:
PO Box, Floor, Apt, Suite:
City:
State or Province:
Zip or Postal Code:
Country, if not USA:

FRIENDS
OF
KERN
DONATION

Annual Donor Levels for Friends of Kern, Inc. (FOK) :
........ Friend (under $100)	........ Supporting ($100 - $499)
........ Sponsor ($500 - $999)	........ Founding ($1,000 and up)
Amount of FOK Donation:	$
Yes No --- OK to List My Name Online as a Donor to Friends of Kern, Inc.?

CAMPER
SCHOLARSHIP
DONATION

Amount of Camper Scholarship Donation:	$
I Wish to Keep This Gift Anonymous	Yes No
Monies will be collected and forwarded to YMCA Camp Kern on a biweekly basis.

DONATION TO
THE CARL B.
KERN FUND

Established in 1987, The Carl B. Kern Fund of The Dayton Foundation is a dedicated fund which pays tribute to Carl B. Kern and the institution of organized camping to which he dedicated his career. Since 1989, distributions from The Carl B. Kern Fund to YMCA Camp Kern have exceeded $110,000, thanks to a Who's Who of Dayton YMCA and YMCA Camp Kern supporters throughout the years.
Accumulated Tiers of Giving for The Carl B. Kern Fund of The Dayton Foundation:
........ HERITAGE MEMBER ($10,000 or more)	........ SPONSOR ($500 - $999)
........ BENEFACTOR ($5,000 - $9,999)	........ FRIEND ($100 - $499)
........ PATRON ($1,000 - $4,999)	........ CONTRIBUTOR (up to $99)
Amount of Carl B. Kern Fund Donation:	$
I Wish to Keep This Gift Anonymous	Yes No
Accept My Gift... (complete one if applicable)
.... in Honor of:
.... OR in Memory of:
Monies will be collected and forwarded to The Dayton Foundation on a biweekly basis.

PAYMENT
OPTIONS

Please click on one of the options below:

I will pay by check, made payable to Friends of Kern, Inc.

I will pay using PayPal online (secure, encrypted payment through PayPal's website)
*** NOTE: a PayPal account is NOT necessary to use this service for credit card payments

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