To make a contribution to Crossworks, please print and fill out the following form (or enclose the following information with your contribution) and mail to the address below.

Name: ______________________________________________

Address: ___________________________________________
         
         ___________________________________________

         ___________________________________________

Email: _____________________________________________

Phone: (____)_______________________________________

Fax: (____)_________________________________________

Enclosed is my contribution of $____________
(All contributions are tax deductible)

Make checks payable to Crossworks

Mail to:
Crossworks
1041 Noell Lane, Plaza B
Rocky Mount, NC 27804

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