Captain Level Donation $150
Lieutenant Level Donation $100
Sergeant Level Donation $50

I would like a (circle one) GOLD SILVER BRONZE membership.
I wish to remain anonymous. _____
Send receipt to: __________________________________________

Print form, fill out, and mail with your tax deductible contribution for your annual membership. Checks only. Please do not send cash.

Mail today to:
Crime Stoppers
PO Box 358404
Gainesville, FL 32635

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