Penny Pines Reporting Form

The following form is to accompany your check to the Forest Service and to
report donations to the CGCI Penny Pines Chairman, Carol Vallens

Individual, Club or District making the donation
The forest service office where check is to be sent. More than one forest office can be selected. Hold down the Ctrl key and click on each selection.
List full name of all individuals or groups being honored. Separate names with semi-colon.
List full name of all individuals being memorialized. Separate names with semi-colon.
This is the TOTAL NUMBER of all plantations included in this donation (general, in honor and/or in memory)
$
Total dollar amount covering all donations listed on this form (1 = $68, 2 = $136 etc.). Checks should be $68 or multiples thereof.
In order for the US Forest Service to provide certificates: Please include the complete mailing address (Name, Street or PO Box, City and Zip Code) where certificate(s) should be sent. Note: If you are honoring/remembering more than one individual, and would like certificates for each individual or family, suggest all certificates be sent to one address (individual, club or district) for distribution.
Individual submitting this form
Email address where we may reach you in the event there are questions.
Print TWO copies before clicking on the Submit button