For donations over $250.00...
1) Please Print and Sign this form.
2) Make Check Payable to: Women Make Movies
3) In the Memo field write: Missing in Action
4) Mail Form and Check to:
    Finca Blanca Media, LLC
    c/o Molly Sackler Wulkowicz
    320 West 56th Street #5G
    New York, NY 10019

WOMEN MAKE MOVIES
FISCAL SPONSORSHIP
CONTRIBUTION CONFIRMATION FORM

Dear Women Make Movies,

I am making a charitable donation in the amount of $__________ for the media project entitled, "Missing in Action: The Women Behind Television's Golden Age" by Molly Sackler & Jason Wulkowicz. I understand that the project is fiscally sponsored by Women Make Movies and that this donation will be spent by the filmmakers towards the production and completion of this media project. I confirm that no services or goods were provided by Women Make Movies, the filmmaker or anyone else associated with the project, in exchange for the charitable contribution.

AGREED TO AND AFFIRMED BY:


Signature of Donor _____________________________ Date _____________


Print Name of Donor ______________________________________________

WOMEN MAKE MOVIES, INC. is the only national multi-cultural women’s media organization whose focus is the promotion, production, exhibition and distribution of films by and about women. Established in 1972, Women Make Movies is a 501(c)(3) non-profit media arts organization registered with the New York Charities Bureau of New York State. As the fiscal sponsor, WMM accepts donations or grants on behalf of the filmmaker and takes the responsibility of administering the funds received in support of the development and completion of the film.