Please enter all relevant information below and then click "Print this Page"
Your Name:
Address:
City:
State:
Zip:
	Please print and mail to:
	Jensen Community Center
	487 North Main St
	Amherst WI 54406

My donation in the amount of is for:

The Lettie W. Jensen General Fund
Chautauqua
Theater Fund
Senior Citizen Outreach Fund

Youth Soccer Fund

Youth Programs