Designation:
_____Food supplies
_____Cleaning supplies
_____Program supplies
_____Gasoline vouchers for
clients
_____Prescription vouchers
for clients
_____Bus ticket vouchers
for clients
_____Building Repairs
_____Building Fund to pay
off mortgage
_____Parking Lot Repairs
_____Computer Fund
_____No Designation
_____In Memory of:______________________
Donation Amount:
$5 ______ $10 ______ $25
______ $50______ $100______
$500 _____ Walk In My Shoes Ghost
Other:____________________________________________
Name_____________________________________________
Address___________________________________________
City______________________
State_____ Zip____________
Phone (____) _____________________
Please send completed form
with your tax-deductible donation made payable to:
307-634-8499
Thank you very much for
your thoughtful gift!
* Remember your donation
can be a tax deduction!