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Fill out completely and fax or mail to Kids Repair Program at the address below

I would like to contribute to the Kids Repair Program.

Name: _________________________________________________________
Address: _______________________________________________________
City: _________________________	State: ___________	Zip: _____________
Phone: (_______) - ________ - _________
E-mail: ________________________________________________________

I have _____ bicycle(s) that I would like to donate to the Kids Repair Program. All bicycles that I am donating are in working condition, appropriate for children, and the following size(s):

O 20-inch wheel diameter:	Number of bicycles of this size: _____
O 24-inch wheel diameter:	Number of bicycles of this size: _____
O 26-inch wheel diameter:	Number of bicycles of this size: _____

I would like to donate $_____ to the Kids Repair Program to be used to help continue the project for the children, I would like to be recognized as a:

O $50 Rear Reflector Donor

O $100 Kick Stand Donor

O $500 Big Spoke Donor

O $1,000 Main Wheel Donor

I can also be a KRP volunteer and work with the children or in the office. I'm available on:

O Tuesday morning	O Thursday morning
O Tuesday afternoon	O Thursday afternoon
O Tuesday evening	O Thursday evening
O Saturday morning

Please mail this form with your check payable to:

KRP Donations
208 Museum Drive
Lansing, MI 48933-1912

Thanks for your generous support!

KIDS REPAIR PROGRAM
208 MUSEUM DRIVE
LANSING, MI 48933-1912
(517) 485-8956
(517) 485-8125 FAX
Email to: Curt 'Grandad' Eure

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