USPA
Pacific Coast Circuit

PACIFIC COAST YOUTH POLO ASSOCIATION Donation Form

Please complete this form to make a cash or equipment donation. Mail the original page with your donation and retain the second page for your records. The Pacific Coast Youth Polo Association is a non-profit organization with tax exempt status 501-C3. All contributions are tax deductible. Mail cash only contributions to: Pacific Coast Youth Polo Association Henry Walker, Treasurer c/o Farmers & Merchants Bank Post Office Box 1370 Long Beach, CA 90801-1370 Mail/deliver equipment contributions to: Pacific Coast Youth Polo Association John Westley, Instructor c/o Santa Barbara Polo & Racquet Club 3375 Foothill Road, #1200 Carpinteria, CA 93013 Donating Company or Individual: Contact Name: _________________________________________________ Mailing Address: ________________________________________________________ ______________________________________________________________________ Phone: _________________________________________ Email Address: __________________________________ Cash donation in the amount of $ _________ is enclosed. (Check or Money Order) Equipment donation (as described below) with an estimated value of $____________ : (please mark delivery/pickup option) _____is enclosed _____ can be picked up _____will be delivered *If your equipment contribution shall be picked up or delivered a PCYPA representative will be contacting you. Equipment description and quantity: Signature:________________________________ Date: _____________ Thank you very much for your generous contribution to our program!

---

Back to Haves & Needs Section