Faith in Action: Elder Outreach

Donation Form

Name ______________________________________________

Address______________________________________________

City___________________________________ State __________

Phone________________________________________________

Email _________________________________________________

Amount donated:

____ $25.00 ____ $50.00 ____ $75.00 ____ $100.00 ____ Other

Is this a donation in honor of someone or a memorial Donation?

Name (and address) of person in whose honor or memory the donation is made:

____________________________________________ 

 ____________________________________________

 ____________________________________________

Please return the completed form with your donation to:

Faith in Action: Elder Outreach

1530 Nicholasville Rd.

Lexington, KY 40503

You will receive a receipt in the mail.

Thank you for your kind support!