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Restricted Contribution Form

Date:____________________

 

United States Rugby Foundation
2131 Pan American Plaza
Balboa Park
San Diego, CA  92101

Dear Director of the United States Rugby Foundation:

Enclosed, please find my contribution check made payable to the U.S. Rugby Foundation (Federal ID Number:  04-6088348) in the amount of $_______________.

This contribution is restricted for charitable use relating to popularizing rugby and supporting related rugby costs (within the USRF's exempt purpose) to be used for:

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(enter name of rugby club/program on line above)

(   )   I have no further restrictions as to the use of the money other than as stated above.

(   )  I have further restrictions in addition to the rugby programs stated above as follows:

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* The USRF will endeavor to follow the donors wishes but maintains variance power to ultimately dispose of the funds as they deem fit.

Please send my charitable contribution acknowledgement to the following address:

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Sincerely:

____________________________________________,            _________________________________
Signature                                                                  Name (Please Print)