Mail-in Donation Form

Please print this page, and mail to the address below.

Donations are tax-deductible.

Enclosed is my donation of (please check or fill in):

$1,000____ $500____ $100____ $50____ $25____ $15____ $________

Name:__________________________________________________________ Address:___________________________________________________________ City:___________________________State:__________ Zip Code:_____________

Daytime Phone: (___)-______________

My donation is in memory/honor of______________________________________

Please send an acknowledgement card to:

Name:_____________________________________________________________ Address:___________________________________________________________ City:___________________________State:__________ Zip Code:_____________