b'The Keystone SocietyBuilding for the Future Capital Fund Pledge Form Building The Keystone Society recognizes Care Resources most generous benefactors; friends in this society have made commitments of $5,000 or more.These leadership gifts are essential tofor the Future building our new Midtown Miami Primary Health Center and Administrative Headquarters.Friend$5,000 to $9,999 Founder$50,000 to $99,999Supporter$10,000 to $24,999 Visionary$100,0000 to $999,999Patron$25,000 to $49,000 Chairmans Circle$1 million or more Capital Fund In recognition of the goals and objectives of Care Resources Building for the Future Fund,I wish to make the following pledge for the total sum of:$ _______________________________ to be paid in its entirety or over ___________ years (12 years)y investment is designated to name __________________________________________________ M room or suite at the Midtown Miami Primary Health Center and Administrative Headquarters ORPlease contact me regarding naming opportunitiesI am interested in donating securities, please send me more informationMy company ____________________________________________has a matching gifts program For Questions Contact:I wish my gift to be anonymousName: ________________________________________________________________________________ Jonathan Welsh Marlene ErvenCorporate Name: _______________________________________________________________________ Associate Director of DevelopmentDevelopmentConsultantAddress: ______________________________________________________________________________ and Communications P: 305-216-0626City, State, Zip: _________________________________________________________________________ P: 305-576-1234 ext. 249 Email: Merven@careresource.orgPhone:_______________________________________________________________________________ Email: Jwelsh@careresource.orgPLEASE INVOICE ME_____________ OR I WISH TO PAY WITH:Check(Payable to Care Resource)Credit CardCard TypeVISAMasterCard AMEXTo learn more or donate:Name as it appears on card: _____________________________________________________________Card Number: _______________________________Exp.____ Date:_______/________CVV#:_______Authorized Signature:___________________________________________ Date:_________________Your gift is tax deductible to the full extent allowed by law.Care Resource Tax ID #59-2564198 DONATE TODAYCare Resource Community Health Centers, Inc3801 Biscayne Blvd., Suite 220, Miami, FL 33137Tel: 305-576-1234, Ext. 249 Email: jwelsh@careresource.org'