I would like to make a contribution to the Houston Chapter ASWA Memorial Fund        Amount $ _________________

In Memory of   (individual is deceased)   In Honor of    (individual is alive)  
       
Print Name ________________________________________  Print Name ________________________________________ 
       
Send acknowledgement to:  Send acknowledgement to: 
       
(Name/Relationship)_________________________________  (Name/Relationship)_________________________________ 
       
(Street) ___________________________________________  (Street) ___________________________________________ 
       
(City, State, Zip) ____________________________________  (City, State, Zip) ____________________________________ 




Donor:   Make checks payable to:  ASWA Memorial Fund  
    Mail to:                                 c/o Eunice H. Reiter  
(Name)___________________________________________                                                  5005 Woodway, Suite 200  
                                                   Houston, TX 77056  
(Street) __________________________________________  
       
(City, State, Zip) ___________________________________