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To become a partner in prevention with CY, or receive more information on our programs simply fill out the form below, or you can e-mail dscott@cssu.org

first name:

last name:

address line 1:

address line 2:

city:

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zip:

Phone:

email:

questions/comments:

Make a Tax Deductible Contribution to CY
If you would like to make a tax-deductible contribution please indicate the amount below. Please make checks payable to "CSSU" and mail them to: CSSU, 5420 Shelburne Rd., #300, Shelburne, VT 05482

I will be mailing a contribution in the following amount:

	$100	To support our peer prevention and leadership activities such as the See Why Improv Troupe, Wild LEAD, and the Diversity Dancers.
	$50	To support our Student Assistance Program that serves young people affected by their own or someone else's drug use.
	$25	To pay for parent education and teacher trainings across the District.
	I would like to make an in-kind donation of goods or services Please specify services below:

Mentoring Program Information
I would like more information on becoming a mentor for a child in the schools.

Aw Shucks Nominees
I would like to nominate the following community volunteer for an "Aw Shucks" award:

"2006 MEMBERSHIP WALL OF FAME"
We invite you to join these community members who supported CY as
partners in prevention for 2006. 2007 members TBA!

BUSINESSES
Ackerman, Beardsley, Bennett, Inc., Buono's, Chef's Corner, Child Travel Services, Climb High, Companion Hardware, Edlund Corporation, Hannaford's, Hart & Mead, Lake Champlain Chocolates, Merchants Bank, NRG Systems, The Bagel, Titus Insurance, Vermont Teddy Bear Co., Charlotte-Shelburne Rotary Club, Community Foundation of Collier County, JB Construction, The Patrick Group, Muzak, Koval's Coffee, Design Signs, New England Air Systems, the Williston Observer, Guy's Farm & Yard,
Sports and Fitness EDGE and PhotoGarden

FAMILIES
Brooks, Bassett-Pane, Hart-Smith, Huntington, Swift-Betz, Fischer, Gladue, McGlenn, Bohlen-McLeod, Prom, Fisher, Cluff, Irish-Kassel, Brown, Hall, Olsen, Snelling, Carlson, Anderson, Barone, Jensen, Volk, Dye, Murakami, Mangione, Stiller, Lawlis, Peterson, Snead,
Bove, & Harris.