Scholarship Fund Contribution:

Please complete the form below and click on "Submit" to make your tax-deductible donation and help ASC provide scholarships to ASCTC campers in need:

To submit this form, all "*" fields must be filled in.

$2500

$1000

$500

$250

$100

Other $

Attribute to the Sidney Stark III Memorial Scholarship Fund

Salutation Mr. Ms. Miss Mrs. Dr. Prof. Rabbi Rev.

First Name*

Last Name*

Address*

City*

State/Province UNITED STATES Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming CANADA Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Region (International)

Zip/Postal Code*

Country

Phone

Email*

Confirm Email*

Yes, I'd like to receive occasional ASC e-newsletters

Payment Info

Acknowledgement

Please list your name(s) as you would like them to appear in our program listings:

I would like this donation to remain anonymous

My employer will match this donation.

Additional Notes

* Please note:  Scholarship fund donations received on or after May 1 will be used in the following calendar year.  For example, your gift made in May 2017 would support a 2018 ASCTC camper.