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Yes! I support Reading ASSIST® Institute’s services for struggling readers.

I am donating: ❑ $1000 Founder’s Circle ❑ $500 Gold Medalist’s Circle ❑ $250 Instructor’s Circle

❑ $100 Mentor’s Circle ❑ $50 Tutor’s Circle ❑ $25 Student’s Circle

❑ $____________________ (Gift of My Choice)

Payment Method: ❑ Check (Payable to Reading ASSIST® Institute)

❑ Charge My Gift: (Please fill out credit card information below.)

Credit Card Information: ❑ MasterCard ❑ VISA ❑ American Express

Account # _______________________________________Expiration Date ___________

Authorized Signature __________________________________________________________________

CORPORATE MATCHING GIFTS: Will your or your spouse’s employer double or triple your gift? If so, please enclose the required forms.

Name ______________________________________________________________________

Please print your name exactly as you wish it to appear in our Annual Report.

Address ____________________________________________________________________

City___________________________________State ______ Zip ________________

Phone ______________________________________________________________________

E-mail ______________________________________________________________________

❑ I am interested in Volunteering. ❑ I am interested in discussing a Planned Gift or Will Designation.

Annual donations support RAI general operations.

Send this form to:

Reading ASSIST Institute

100 West 10 th Street

Suite 910

Wilmington, DE 19801