DONATION FORM

Thanks for your donation to Team USA Wheelchair Rugby.  Please print out this page and include it with your check so that we can properly direct your contribution.
 
 
Your Name:                                                                                                                                                
Your Address:                                                                                                                                            
City, State Zip:                                                                                                                                           
Phone Numbers: (       )                                                             (       )                                                       
Email Address:                                                        @                                                                               
 
Enclosed is my check payable to Team USA Wheelchair Rugby in the amount of $                      
 
Please use my donation towards the general needs of Team USA                           
 
Please use my donation towards the expenses of:                                                                               
 
Special Instructions:                                                                                                                                   
                                                                                                                                                                      
                                                                                                                                                                      
 
Mail checks to:

Team USA Wheelchair Rugby
5861 White Cypress Drive
Lake Worth, Florida 33467
 
 
 

Tax Deductions
Team USA Wheelchair Rugby is part of the United States Quad Rugby Association, which is a non-profit 501 (c)(3) organization.  As such, all of or a part of your donation to Team USA may be tax deductible.  Please consult with your tax professional for more information.  Proof of our 501 (c)(3) status is available upon request.