Congressional Black Caucus Foundation, Inc.

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THE CBCF SPOUSES’ COMMUNITY WISH LIST
REGISTRATION FORM

First Name *

Last Name *

Company

Address *

City *

Zip *

Phone *

Fax

Email *

Please check your selected program(s) you would like to help.

	Anna Cooper House		Jordan House
	Behavioral Health Services		Mary Claire House
	Center For Employment Training (Cet)		Kirwan House
	Dining Room		Leland Place
	Dwelling Place Senior Center		Shalom House
	Dwelling Place Shelter For Abused Elderly		Some Place For Kids
	Exodus House And Maya Angelou House		Thea Bowman House
	Harvest House For Women		Joseph Smith House
	Independence Place		Freedom House
	Isaiah House		Zagami House
	Jeremiah House

Please check your selected contribution(s) you would like to make.

	Artificial Sweetener	Minivan
	Coffee	Plus Size Men and Women's Casual Clothing
	Correll Plates and Mugs	Plus Size Men and Women's Professional Clothing
	Hooked on Phonics Programs	Sylvan Computer Curriculum
	Laptops	Twin Mattresses and Box Springs
	Low Sugar Cereal	Underwear and Socks
	Lunchmeat	Video Camera (small)
	Mattresses and Bow Springs with Inverted Seams	Work shoes
Other:

* This field is required.

The CBCF is a nonprofit, nonpartisan 501c(3) organization. Federal Tax ID: 52-1160561. Contributions are deductible to the extent allowed by law.

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Congressional Black Caucus Foundation, Inc. 1720 Massachusetts Ave., NW Washington, DC 20036 (202) 263-2800