Equipment Donation Form

I would like to purchase ____________________________________________________________

as a donation to the Sangamon Valley Youth Symphony.

Total donation enclosed $ ____________________

Name: ________________________________________________________

Address: ______________________________________________________

Telephone: _____________________________________________________

Please print this page and send it with your check (payable to Sangamon Valley Youth Symphony) to:

You will receive an ancknowledgment letter for tax purposes. Please contact Mr. Haglund before sending this donation to be sure the item is still on his "equipment needs" list. Thank you!