Ropes & Gray Model Form

The Arc of Monroe County, NYSARC, Inc

OPT-OUT FORM: FUNDRAISING We have sent you materials to raise funds for The Arc of Monroe County. If you do not want to receive fundraising communications in the future, please complete the following form and return it to the address provided below. After we receive this form, we will make every reasonable effort to ensure that you will not receive such communications in the future. INFORMATION ABOUT THE PERSON SERVED Name: Last

First

Address:

MI

Telephone: ______________________ (daytime) ______________________ (evening) Email:

OPT-OUT INFORMATION Do you want to stop receiving ALL fundraising materials that benefit The Arc of Monroe County? (Check One)

Yes _____ No _____

If you answered No above, please describe what types of materials you do not want to receive:

What is the title of the fundraising material we sent you? (Optional)

Fundraising opt out form

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The Arc of Monroe County, NYSARC, Inc

Is there a reason that you do not want to receive future fundraising communications? (Optional)

_________________________________________ Signature of Person or Personal Representative

SEND COMPLETED FORM TO:

_________________________________________ Print Name of Person or Personal Representative

The Arc Foundation 985 Elmwood Ave.,

_________________________________________ Personal Representative’s Authority

Building 10 Rochester, NY 14620

____________________ Date

For The Arc of

Monroe County Use Only:

Date Received: (MO/DY/YR) ____/____/____ Name of Fundraising Staff Member Processing This Form: ___________________________________

Fundraising opt out form

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