Photo of C.B. Kern THE CARL B. KERN FUND
of The Dayton Foundation

established 1987

1401 S. Main Street, Suite 100  *  Dayton, OH 45409
(937) 222-0410  * * *  FAX: (937) 222-0636

Dayton Foundation Logo
The Carl B. Kern Fund - Donor Form
[click for a printable version] .  

Although online payments cannot be made through this form, we ask that you complete the following information so that your donation can be appropriately documented and recorded.

Click the Confirm Donation Button button at the bottom to produce a summary of your information that you can confirm, print and mail with your donation. THANK YOU!

Your Name:
Street Address, Line 1:
Street Address, Line 2, if any:
City, State/Province, Zip/Postal Code:
Preferred Phone No., with Area Code:   Home   Bus.   Cell
Your E-Mail Address:
Amount of Donation:$  
Should this gift be anonymous?: NO     YES
If NO, list how name(s) should appear:
==> Please complete the information below if you want this to be an honorary or memorial gift, which will be recognized online. You can also acknowledge this gift to individual(s) you specify plus add any comments on why you want to recognize this person.
Donation is in Honor  Memory of: Name(s):  
Please acknowledge this gift to:
  (Please enter name and address. If
  you don't know the address, we'll try
  to find it - just give us a few hints!)
Any comments on why you are
recognizing this person/these people?
  (Use other side of printed form
  if more space is needed):
Keep these comments anonymous?: NO     YES