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

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

Name     ________________________________________________________

Address ________________________________________________________

_______________________________________________________________

Phone __________________________________________________________

I wish to make my gift

[ ] Donation In Memory Of _________________________________________________

[ ] Donation In Honor Of ___________________________________________________

[ ] Deceased's Name _____________________________________________________

[ ] Where to send acknowledgement __________________________________________
______________________________________________________________________

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

PO Box 2432

Greenville, NC 27836