The Hollywood Walk of Fame Project

The Hollywood Walk of Fame Project

CONTRIBUTOR INFORMATION FORM
Please note, this form is for maintenance of our financial records only; absolutely none of the following information will be made public, except for your name should you wish for it to appear on our Contributors page.

If you experience any technical difficulty with this form: You may also download and
print this PDF version and mail it to: Hugh Jackman Hollywood Walk of Fame Fund,
PO Box 1811, Loveland, CO, 80539-1811, USA

Name:
Street Address:
City: State/Province/Etc.:
Zip/Post Code:
Country:
Email address:

Amount donated: $
(If you need to calculate the amount in $US from your own currency, we recommend Yahoo's Currency Converter.)

Would you like your name to appear on a list of contributors to this project?

Yes
No

If you selected Yes, how would you like your name to appear on the page? (Nicknames, screennames, etc. are fine):

This contribution of goes toward a star on the Hollywood Walk of Fame honoring Hugh Jackman. I understand this donation will be deposited in a savings account until such time as the star is awarded and fees must be paid. I further understand that any interest earned prior to the star being awarded will be donated to charity, specifically The Lighthouse Foundation in Australia.

Name:
Date:

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