Yes, I want to support D-FY-IT of Midland helping the
youth of Midland County stay drug and alcohol free!

 Print this form, fill out, and mail to D-FY-IT of Midland with your donation.

 Donation enclosed $ ______________________

Please make checks payable to D-FY-IT of Midland, Inc.

Signature                                                                                                    Date

Please address all communications concerning this donation to:
Name: ____________________________________________________
Address: __________________________________________________
City: _____________________     State: ___________     Zip: _______
Home Phone: ________________     Work Phone: _________________

Yes, My Company offers a matching donation opportunity:
Company Name: ____________________________________________
Contact Name: _____________________________________________
Business Address: ___________________________________________
Business City: _______________ State: ____________     Zip: _______

D-FY-IT is a 501(c)(3) non-profit organization. All contributions are tax deductible. For further information, please contact,
Executive Director, Mitchell Moore at 432-685-3645 or Program Director, Cassie Dresel at 432-689-5846.

PDAP: Palmer Drug Abuse Program - 1201 West Texas Avenue - Midland TX 79701

D-FY-IT of Midland, Inc. - Drug Free Youth In Texas - 615 W. Missouri, #237 - Midland TX 79701