Mail in Donation Form
Please print this page.

I’d like to make a one-time donation to CPEP in the following amount:

$25 $50 $100 $250 $500 $1000 Other: $_________

I want to make monthly contributions to CPEP. Enclosed is my first
monthly donation of:

$25 $50 $100 $250 $500 $1000 Other: $_________

Thank you for your generosity. All donations are tax-deductible as allowed by law. Please make
checks payable to CPEP. Thank you!

Name:____________________________________

Address:__________________________________

City:_____________________________________

State: _________ Zip:______________

Phone: ___________________________________

E-mail Address: ____________________________

Fill out and mail this entire form along with your donation to:

CPEP
45 Wintonbury Ave.
Bloomfield, CT 06002