Donations & Memorials

Donations can be made to commemorate special occasions, honor special individuals & accomplishments, or remember friends or loved ones who have passed away. Your gift will help fund Diabetes Matters^TM patient education and support services and Camp Ho Mita Koda for children with diabetes.

To help us acknowledge your gift correctly, please complete:

DONOR INFORMATION:
Name:	Mr. Mrs. Ms. Miss Dr. Mr. & Mrs. First: Last:
Address:
City:
State:	Zip:
Home Phone:
Work Phone:
E-Mail:
This gift is made to the:	Annual Fund St. Joseph Academy Swim for Diabetes Steven P. Arnold Walkathon Lend Each A Hand (helps provide supplies to people in need) Robert J. Munz Memorial Fund Fisher Medic Alert Bracelet Fund Dale Nash Fund Sallie Christman Lybarger Fund
Designate my gift to:	Diabetes Education and Services Camp Ho Mita Koda Where most needed
In Honor of: In Memory of: In Support of Swimmer:

Giving Levels:
Donors of $25 or more are recognized according to the following giving levels:

$25-$99	Partner
$100-$499	Benefactor
$500-$999	Patron
$1,000-$2,499	Leadership Society*
$2,500-$4,999	President's Club*
$5,000+	Chairman's Circle*

*Receives invitation to annual donor recognition event.

Credit Card:	Master Card Visa
Card #
Expires:
Please charge my One Time Only tax deductible contribution of: $
Please charge my Monthly tax deductible gift of: $ (5, 10, 20, 50 etc.) I and/or my spouse (spouse name: ) work(s) for a Matching Gift Company, increasing the value of my/our gift. Company(s) with gift matching: Download a List of Matching Gift Companies (68KB Acrobat .PDF file)
Please send notification of my gift to: The amount of your gift will not be specified.
Name:	First: Last:
Address:
City:
State:	Zip:

     

THANK YOU! Your gift is building a foundation for the future.