Check all the lines Below to Find Out More
Information or to Make a Donation.
____ Send Me Information on Your Memorial Brick Pavers.
____ Send Me Information on Ambassador/Volunteer Opportunities (Front Desk, Data Entry, Handyman,Virtual Visiting Hour Host)
____ I Want More Information on Your "Tea and Tour" program" - Group tours of facility that include refreshments.
____ Please Accept My Tax Deductible Contribution, Payable to Molly's House.
____ I Would Like a Speaker for My Group or Organization.
____ Send Me Your Wish List for an In-Kind Donation
____ I would like more information on Molly's Gallery Exhibits (September - May)
____ I would like information on the annual Golf Tournament (March)
____I would like information special events for Molly's House
____Adopt a Family program - $50 contribution goes towards subsidizing a family stay
Name:________________________________________________Phone:______________________
Address, ____________________________________________City_____________Zip___________
E-Mail Address: ____________________________________________________________________
Credit Card Donations
Credit Card Type: Visa MasterCard
Credit Card Number: _________________________________
Expiration Date: ______________________________
Signature:__________________________________
