In the Amount of:


Billing Options (choose one):

I will mail my donation on
(mail to: 61 Main St., Wakefield, RI 02879), or
Bill Me Quarterly
Bill Me Bi-Annually

Donor Information:

Name:

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I would like my donation to be used for (choose one):
Where it is most needed
The Adopt-A-Room Program
The Safe Home fund
The Annual Appeal
The Endowment Fund
a Specific Program or Service. Please Specify:

This gift is in honor of , or in memory of :
(Please provide name and address for acknowledgement)

I am employed at a matching gift company.
Please specify name and address:

Please send information about volunteering
Do not list my name as a donor
Please contact me regarding planned giving options.

Thank you for your generous support.