2722 NE 20th Court Fort Lauderdale, FL 33305 Double your (philanthropic) pleasure Between February 1 - 14, 2013 Help us turn $50,000 into $100,000+ are better than A matching gift program for Valentine’s Day Our Fund will match gifts from new donors1 or increased gifts2 from current donors who make a gift of $500.00 to a local non-profit organization serving the LGBT community in South Florida11 The Following restrictions apply: 1. A “New Donor” is defined as a donor who has not contributed to the organization within the past 18 months. 2. An “Increased Gift” is defined as any new amount over and above the amount a donor has given in the past twelve months. 3. Gifts must be received between February 1st and February 14th, 2013 only. 4. Donor’s gift must be at least $500. 5. Maximum matching gift from Our Fund will be $500 per donor. Donors may contribute to multiple quali- fied organizations. 6. Maximum amount of matching gifts to each non-profit organization will be $5,000. 7. Maximum of $50,000 in matching gifts have been committed. Program expires on February 14, 2013 or when $50,000 in matching gifts have been committed. 8. Gifts accepted in order of receipt and must accompany this form. 9. Donor’s portion and matching gift portions to be distributed to non-profits at the end of the program. 10. Eligible participating organizations will be incorporated in Florida, provide direct services to the LGBT com- munity in Florida only and are very active in South Florida (Palm Beach, Broward and Miami-Dade Counties). Or- ganizations listed on this form are the only organizations eligible for the matching gift. 11. Each donor will receive recognition by the non-profit and Our Fund. 12. Application included on the reverse side must be fully completed and signed by the donor and the non- profit organization confirming that gift qualifies for the match as noted on this form. 2722 NE 20th Court Fort Lauderdale, FL 33305 Our Fund’s Community Matching Gift Program - February 2013 Enclosed is my check for $______________ payable to Our Fund for the benefit of __________________________________________________________________ (Qualified non-profit organization from list below) My gift complies with the terms of Our Fund’s Community Matching Gift Program noted on the reverse side of this form. Gift will be matched by Our Fund in accordance with the restrictions noted as part of this program and sent to the par- ticipating non-profit organization. ________________________________________________ This gift from donor noted on the left complies with Donor’s Signature the terms of Our Fund’s Community Matching Gift Program. ________________________________________________ Print Name _____________________________________ Non-Profit Organization’s Name ________________________________________________ Address _____________________________________ CEO, President or Executive Director Signature ________________________________________________ City, State, Zip _____________________________________ ________________________________________________ Print Name Email address Participating Non-Profit Organizations Serving the LGBT Community in South Florida ACLU of Florida Gay Men’s Chorus of Safe Schools South Florida www.aclufl.org South Florida www.safeschoolssouthflorida.org www.gmcsf.org Aqua Foundation Sanctuary House www.aquafoundation.org Gilda’s Club South Florida www.sanctuaryhouse.info www.gildasclubsouthflorida.org Arts United SAVE Dade www.artsunitedflorida.com Humanity Project (www.savedade.org) www.thehumanityproject.com Brian Neal Fitness & Health South Florida Symphony Orchestra Foundation Island City Stage www.southfloridasymphony.org www.briannealfitness.org www.islandcitystage.org Stonewall National Museum Broward House Latinos Salud and Archives www.Browardhouse.org www.latinossalud.org www.stonewallnationalmuseum.org Care Resource Legal Aid/BHRI SunServe www.careresource.org www.legalaid.org/broward www.sunserve.org Church of the Holy Spirit Song Miami Gay & Lesbian Film Festival Sunshine Cathedral www.cohss.org www.mglff.com www.sunshinecathedral.org Compass Community Center Pet Project for Pets Tuesday’s Angels www.compassglcc.org www.petprojectforpets.org www.tuesdaysangels.org Equality Florida Pride Center Unity Coalition|Coalicion Unida www.eqfl.org www.pridecenterflorida.org www.unitycoalition.org Fort Lauderdale Gay & Lesbian Red Hispana Women in Network Film Festival www.redhispanafl.org www.womeninnetwork.com www.flglff.com .