Print this form and mail to the address below.

All gifts are 100% tax-deductible.

501(c)3 entity

                                            I Wish To Support

            the  Cody Blue Pilkington Scholarship Fund

Enclosed is my tax-deductible gift of $___________ for the CBP Scholarship Fund.

Name     ________________________________________________________

Address ________________________________________________________

_______________________________________________________________

Phone __________________________________________________________

I wish to make my gift

[ ] In Honor Of ____________________________________________________

[ ] In Memory Of___________________________________________________

Please acknowledge my gift

[   ] To the Same address as above

or to

Name ___________________________________________________________

Address _________________________________________________________

Phone____________________________

Please make checks payable to:

NCCF –

Cody Blue Pilkington Scholarship Fund

PO Box 2432

Greenville, NC 27836