Donor Information

Thinking Big ~ Saving Lives

Donor Information
Name	     
Street Address	     
City-State-ZIP Code	     
Home Phone	     
Work Phone	     
E-Mail Address	     

Gift Information

Gift Amount:      (Please make check payable to Life Support) (OPTIONAL) What prompted you to make a donation? (Example: Life Support event, friend/family, etc.):      Would you like this gift to be anonymous?:       Is this gift in memory or honor of someone? If so, who?:     

Who should we send gift recognition to?
Name	     
Street Address	     
City–State-ZIP Code	     

Please “SAVE” this form and mail to: Life Support
PO Box 264
South Cle Elum, WA 98943

Life Support is a non-profit organization.

All donations are tax deductible under 501(c)(3) or the IRS Code according to law.