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Donation Information
Donation Amount
*
$1000
$3000
$5000
$10000
$25000
Other amount listed below
Other Amount
I designate my donation to be used as indicated below:
*
CMH Foundation - General Support
CMH Foundation - Scholarship Fund
CMH Foundation - Capital/Building Fund
CMH Foundation - Endowment Fund
CMH Foundation - Care-A-Van Fund
CMH Foundation - Annual Appeal
CMH Auxiliary - General Support
CMH Auxiliary - Lifeline Program Fund
Other Gift or Payment
Please indicate how you would like your name displayed in any donor recognition for this gift (i.e. John & Susan Smith, Smith Family, Susan Smith)
Additional Instructions For My Gift
Memorial given in memory/honor of:
First Name
Last Name
I would like an acknowledgement to be sent to the person/family honored at the address below.
Address
City
State
Zip
I prefer to remain anonymous
I would like more information on Estate Planning
Special instructions/note about the gift: