Please send an acknowledgement to the individual or organization to whom I am dedicating my donation.







I want my donation to be listed as:
In Memory OfHonoring




Name of person in whose MEMORY donation is being made:

Names of persons being notified:

Address:

Phone no. or email address: (optional)

If you need additional people notified - use this space:



OR


Name of person in whose HONOR donation is being made:

Names of persons being notified:

Address:

Phone # or email address (optional)

If you need additional people notified - use this space:



Donor's name:

Donor's address:

Donor's phone and/or email:

Donation amount
$


Your message to this special person or family ....