MAIL your contribution directly to the Family Planning Center of Ocean County, Inc. at 290 River Ave., Lakewood, NJ 08701. Please print this form, complete it, and mail it to us as soon as possible, so we can process your donation. Donations to the FPCOC can be made by check, credit card or the electronic transfer of funds. Please do not send cash through the mail.

Donor Information

Name _________________________________________________

Address _______________________________________________

City ___________________________ State ____ ZIP __________

Phone ____________________________ Fax _________________

Email _________________________________________________

Donation Information

I wish to make a single donation of $35     $50     $100     $500     Other: $_______


I wish to make a weekly or monthly donation of $__________.

Payment Options

Check enclosed. Please make checks payable to the Family Planning Center of Ocean County, Inc.

Please bill my: Visa     MasterCard     American Express     Discover

Card #________________________________ Exp.___________

Signature _____________________________________________

Matching Gifts

My company will match (or double, or triple) my gift.

I have enclosed the company's matching gift form.


In-kind Contributions

I have a contribution of equipment, supplies, professional services and/or personal property to give.

Please have a member of the FPCOC Development staff contact me.

Planned Gifts

I would like information on how to make a gift of one or more of the following: stocks; bonds; mutual funds; an insurance policy; a gift through a will; a bequest; a charitable remainder trust.

Please have a member of FPCOC’s staff contact me.
I have enclosed information regarding my gift.

Gifts of Tribute

I would like to make a gift in honor of someone special.

This is a Memorial Gift in honor of ____________________________.

This gift is in honor of _________________________ on the following occasion:


Please use the information below to send a personal letter notifying the recipient of my gift.

Recipient(s) _____________________________________

Address __________________________________________

City ______________________ State ____ ZIP _______

Please convey the following thoughts in the acknowledgment letter:




I am interested in receiving additional information about FPCOC’s:

Email Alerts

Annual Giving Letter Annual Giving Letter Annual Giving Letter Email Alerts (Held Every Fall) 



Look Who’s Cooking Invitation (Held Every Spring) 

Look Who’s Cooking Ad Journal

Look Who’s Cooking Chef Invitation

Boscov's Fund-raiser - $5 Tickets - 25% Off Shopping Pass (Held Every October) 

Other ____________________________