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Name___________________________________________

SS#  ___ ___ ___ - ___ ___ - ___ ___ ___ ___

Address_________________________________________

City___________________   State______   Zip__________     

Enclosed is my check for $______________.

Make check payable to Camelback High School. Mail it directly to the school and it must be postmarked by December 31, 2011.   Address the envelope to:
       

          Camelback High School
          Bookstore -- AZ Tax
          4612 N. 28th Street
          Phoenix, AZ 85016
 

Name of Club or Activity to be credited with the donation:

______________________________________________

If no Club or Activity is named, your donation will go into a general fund for all clubs and activities.