Calumet Regional Science Fair & Associated Art Exhibit
Grant Donation Form

Thank you so much for your support! The Calumet Regional Science Fair and Associated Art Exhibit can not encourage the students of Lake County without the support of the community. In order to properly acknowledge your gift, won't you please fill out the following form? If you would like the gift to be anonymous, we will be happy to comply with your wishes. We will have a page posted on the web, as well as signs and brochures at the Science Fair gratefully acknowledging our benefactors.

Name: _______________________________________

Address: _____________________________________

City, State, Zip: _________________________________

Company (if applicable): __________________________

Phone: _______________________________________

e-mail: _______________________________________

Donation: _____________________________________

Special Instructions: _____________________________
mail to: Calumet Regional Science Fair
              c/o Chemistry Department
              Indiana University Northwest
              3400 Broadway
              Gary, IN 46408

or fax to: (219) 980-6637
or e-mail to lwoz@iun.edu